ImportanceRecurrence is one of the most challenging adverse events after ventral hernia repair as it impacts quality of life, utilization of resources, and subsequent need for re-repair. Rates of recurrence range from 30% to 80% after ventral hernia repair.ObjectiveTo determine the contemporary ventral hernia recurrence rate over time in patients with previous hernia repair and to determine risk factors associated with recurrence.Design, Setting, and ParticipantsThis retrospective, population-based study used the Abdominal Core Health Quality Collaborative registry to evaluate year-over-year recurrence rates in patients with prior ventral hernia repair between January 2012 and August 2022. Patients who underwent at least 1 prior ventral hernia repair were included and categorized into 2 groups based on mesh or no-mesh use. There were 43 960 eligible patients; after exclusion criteria (patients with concurrent inguinal hernias as the primary diagnosis, nonstandard hernia procedure categories, American Society of Anesthesiologists class unassigned, or no follow-up), 29 834 patients were analyzed in the mesh group and 5599 in the no-mesh group.Main Outcomes and MeasuresVentral hernia recurrence rates. Risk factors analyzed include age, body mass index, sex, race, insurance type, medical comorbidities, American Society of Anesthesiologists class, smoking, indication for surgery, concomitant procedure, hernia procedure type, myofascial release, fascial closure, fixation type, number of prior repairs, hernia width, hernia length, mesh width, mesh length, operative approach, prior mesh placement, prior mesh infection, mesh location, mesh type, postoperative surgical site occurrence, postoperative surgical site infection, postoperative seroma, use of drains, and reoperation.ResultsAmong 29 834 patients with mesh, the mean (SD) age was 57.17 (13.36) years, and 14 331 participants (48.0%) were female. Among 5599 patients without mesh, the mean (SD) age was 51.9 (15.31) years, and 2458 participants (43.9%) were female. When comparing year-over-year hernia recurrence rates in patients with and without prior mesh repair, respectively, the Kaplan Meier analysis showed a recurrence rate of 201 cumulative events with 13 872 at risk (2.8%) vs 104 cumulative events with 1707 at risk (4.0%) at 6 months; 411 cumulative events with 4732 at risk (8.0%) vs 184 cumulative events with 427 at risk (32.6%) at 1 year; 640 cumulative events with 1518 at risk (19.7%) vs 243 cumulative events with 146 at risk (52.4%) at 2 years; 731 cumulative events with 670 at risk (29.3%) vs 258 cumulative events with 73 at risk (61.4%) at 3 years; 777 cumulative events with 337 at risk (38.5%) vs 267 cumulative events with 29 at risk (71.2%) at 4 years; and 798 cumulative events with 171 at risk (44.9%) vs 269 cumulative events with 19 at risk (73.7%) at 5 years. Higher body mass index; immunosuppressants; incisional and parastomal hernias; a robotic approach; greater hernia width; use of a biologic or resorbable synthetic mesh; and complications, such as surgical site infections and reoperation, were associated with higher odds of hernia recurrence. Conversely, greater mesh width, myofascial release, and fascial closure had lower odds of recurrence. Hernia type was the most important variable associated with recurrence.Conclusions and RelevanceIn this study, the 5-year recurrence rate after ventral hernia repair was greater than 40% and 70% in patients with and without mesh, respectively. Rates of ventral hernia recurrence increased over time, underscoring the importance of close, long-term follow up in this population.

中文翻译：

---

腹疝的同比复发率和危险因素

重要性复发是腹疝修复术后最具挑战性的不良事件之一，因为它影响生活质量、资源利用以及随后的重新修复需求。腹疝修补术后复发率范围为 30% 至 80%。目的确定既往疝修补患者随时间推移的当代腹疝复发率，并确定与复发相关的危险因素。设计、设置和参与者本回顾性人群-基于腹部核心健康质量协作注册的研究评估了 2012 年 1 月至 2022 年 8 月期间接受过腹疝修补术的患者的逐年复发率。接受过至少 1 次腹疝修补术的患者被纳入其中，并分为 2 组基于网格或无网格使用。有43 960名符合条件的患者；根据排除标准（主要诊断并发腹股沟疝气的患者、非标准疝气手术类别、美国麻醉医师协会类别未分配或无随访），网状组中分析了 29 834 名患者，无网状组中分析了 5599 名患者.主要结果和措施腹疝复发率。分析的风险因素包括年龄、体重指数、性别、种族、保险类型、医疗合并症、美国麻醉医师协会等级、吸烟、手术指征、伴随手术、疝气手术类型、肌筋膜松解、筋膜闭合、固定类型、数量先前的修复、疝宽度、疝长度、补片宽度、补片长度、手术方法、先前的补片放置、先前的补片感染、补片位置、补片类型、术后手术部位发生情况、术后手术部位感染、术后血清、引流管的使用，以及结果 29 834 例网片患者中，平均（SD）年龄为 57.17（13.36）岁，其中 14 331 例（48.0%）为女性。在 5599 名没有网片的患者中，平均 (SD) 年龄为 51.9 (15.31) 岁，2458 名参与者 (43.9%) 为女性。当分别比较接受过和未接受过补片修复的患者的疝复发率时，Kaplan Meier 分析显示，复发率为 201 次累积事件，其中 13 872 人处于危险之中 (2.8%)，而复发率为 104 次累积事件，其中 1707 人处于危险之中(4.0%) 6 个月时； 1 年时，累计发生 411 起事件，其中 4732 人面临风险 (8.0%)，而 1 年内发生 184 起累积事件，其中 427 人面临风险 (32.6%)； 2 年时，累计发生 640 起事件，其中 1518 人面临风险 (19.7%)，而 2 年内发生 243 起累积事件，其中 146 人面临风险 (52.4%)； 3 年时，累计发生 731 起事件，其中 670 人面临风险 (29.3%)，而 3 年内发生 258 起累积事件，其中 73 人面临风险 (61.4%)； 4 年时，累计发生 777 起事件，其中 337 起有风险 (38.5%)，而 267 起累积事件，其中 29 起有风险 (71.2%)； 5 年时，798 起累积事件，其中 171 起有风险 (44.9%)，而 269 起累积事件，其中 19 起有风险 (73.7%)。较高的体重指数；免疫抑制剂；切口疝和造口旁疝；机器人方法；疝气宽度更大；使用生物或可吸收的合成网；手术部位感染和再次手术等并发症与疝气复发的几率较高有关。相反，网片宽度越大、肌筋膜松解和筋膜闭合的复发几率越低。疝气类型是与复发相关的最重要的变量。结论和相关性在本研究中，有和没有补片的患者腹疝修复术后 5 年复发率分别大于 40% 和 70%。腹疝复发率随着时间的推移而增加，强调了对该人群进行密切、长期随访的重要性。