Factors associated with venous thromboembolism in retromuscular ventral hernia repair - an abdominal core health quality collaborative analysis

Purpose: The purpose of this study was to identify patient and operative factors that increase the likelihood of VTE after RVHR. Methods: Patients aged 18 and older who underwent RVHR for a midline ventral hernia with 30-day follow-up in the Abdominal Core Health Quality Collaborative (ACHQC) database were included. Those who were under 18 years of age, had incomplete 30-day follow-up, lacked operative details, and or had inguinal or lateral abdominal wall hernia repair were excluded. A variety of patient demographic and operative factors were collected. Chi-squared tests were used to evaluate significance. A p-value of 0.05 was used as the level of statistical significance. Results: 7422 patients were included in the final study. BMI > 30 (p = 0.0061), age > 60 (p < 0.0001), ASA class (p = 0.0002), median hernia size (p < 0.0001), prior mesh placement (p = 0.0003), and hernia recurrence (p = 0.0043) were significantly associated with VTE. Operative approach (p = 0.562), OR time > 2 h (p = 0.0708), males (p = 0.9924), diabetes (p = 0.4256), history of abdominal wall SSI (p = 0.3793), and any intraoperative complication (p = 0.3277) were not significantly associated with VTE. Conclusion: Beyond established patient factors, larger defect width was independently associated with 30-day VTE after RVHR. Complexity markers–including recurrent hernia, prior mesh, and larger mesh dimensions–also tracked with VTE, and pre-operative anticoagulant therapy was more frequent among VTE cases, informing RVHR specific risk stratification and prophylaxis.