Preoperative prediction of major postoperative morbidity after ventral hernia repair: a parsimonious model developed and internally validated in a single-center cohort.

Authors

Antonio Ramos Bonilla

Published in

Hernia : the journal of hernias and abdominal wall surgery. Volume 30. Issue 1. Oct 30, 2026. Epub Oct 30, 2026.

Abstract

Major morbidity after ventral hernia repair (VHR) is common, yet preoperative tools to estimate it at the point of surgical decision-making are scarce. We aimed to develop and internally validate a parsimonious model predicting 90-day Clavien-Dindo ≥ II morbidity using only preoperative variables.
We analyzed 1,263 ventral hernia repairs (511 incisional, 752 primary) from a prospectively maintained institutional registry (2020-2026). Nine prespecified routinely available preoperative predictors - age, BMI, active smoking, type 2 diabetes, ASA ≥ III, incisional hernia phenotype, recurrent hernia, large defect (≥ 4 cm) and emergency surgery - were entered into a LASSO logistic regression model. Discrimination (area under the ROC curve, AUC) and calibration (graphically, Brier score) were assessed; internal validation used bootstrap resampling (B = 1,000). A simplified integer score was derived.
Major morbidity occurred in 121 patients (9.6%). All nine were retained, emergency surgery and large defect size weighing most heavily. The model showed good discrimination (apparent AUC 0.766, 95% CI 0.718-0.810; optimism-corrected 0.751) and satisfactory calibration (Brier score 0.076). The score stratified patients across a wide gradient, from 4.3% observed morbidity in the lowest-risk group to 40.0% in the highest. A binary threshold (≥ 35 points) classified 21.9% of patients as high-risk, with a 5.6-fold higher morbidity rate and a negative predictive value of 95.2%.
A parsimonious nine-variable preoperative score predicts 90-day major morbidity after VHR with good discrimination and calibration. Its high negative predictive value may help identify patients potentially suitable for ambulatory or fast-track pathways. External multicenter validation is required before routine adoption.

PMID:
42961513
Bibliographic data and abstract were imported from PubMed on 31 Oct 2026.

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