Does defect size matter? Risk of venous thromboembolism and pulmonary embolism after ventral hernia repair.

PURPOSE: New CPT codes for Ventral hernia repair (VHR) by fascial defect size were introduced in 2023. Venous thromboembolism (VTE) and pulmonary emboli (PE) represent potentially preventable postoperative complications with significant morbidity. We studied the association between hernia fascial defect size and postoperative outcomes. METHODS: We identified patients in the 2023 National Surgical Quality Improvement Program (NSQIP) dataset and stratified by hernia defect size, type, and severity. Descriptive statistics were calculated. Relative risk was modeled by logistic regression. RESULTS: A total of 12,947 VHRs were recorded: 46% <3 cm, 42% 3-10 cm, and 12% >10 cm. There were 29 (0.2%) instances of VTE: 6 (0.1%), 10 (0.2%), and 13 (0.8%) for <3 cm, 3-10 cm, and > 10 cm respectively (p < 0.001). Similarly, there were 27 (0.2%) instances of PE: 5 (0.1%), 10 (0.2%), and 12 (0.8%), respectively (p < 0.001). Due to the differences in patients between the groups, relative risks were modeled by logistic regression. Relative risk (95% CI) of VTE compared to <3 cm was 1.05 (0.38, 2.92) for the 3-10 cm group and 2.45 (0.88, 6.77) for > 10 cm. The relative risk (95% CI) of PE compared to <3 cm was 1.62 (0.55, 4.83) for the 3-10 cm group and 3.59 (1.18, 10.91) for > 10 cm. Further analysis showed a higher incidence of PE (20 [0.2%] vs. 7 [0.5%], (p = 0.01) for recurrent hernias compared to initial presentation. STRATIFYING BY OPERATIVE APPROACH DEMONSTRATED SIGNIFICANTLY INCREASED RISK OF BOTH VTE AND PE IN FASCIAL DEFECT SIZE > 10 CM WHEN REPAIRED LAPAROSCOPICALLY: 6.63 (1.32, 33.4) AND 9.69 (1.79, 52.4) RESPECTIVELY. CONCLUSION: While the unadjusted relative risk of both VTE and PE was higher with bigger fascial defects, adjusting for both patient demographics and medical history revealed an association between increasing risk of PE and fascial defect > 10 cm. Further, the laparoscopic approach is associated with greater risk of both DVT and PE when the fascial defect size is > 10 cm. Chemical thromboprophylaxis should be considered for patients undergoing VHR if their fascial defect is > 10 cm.