Modified Hernia Grading Scale to Stratify Surgical Site Occurrence after Open Ventral Hernia Repairs

Abstract

BACKGROUND: The lack of a universally accepted classification system for incisional hernia repair has led to inconsistent reporting of ventral hernia repairs, the inability to compare various series, and the lack of appropriate risk adjusted stratification systems to evaluate surgical outcomes. This study evaluates the Ventral Hernia Working Group's (VHWG) grading scale to accurately predict surgical site occurrence (SSO) after open ventral hernia repair. STUDY DESIGN: All open ventral hernia repairs performed at Case Medical Center were evaluated from a prospectively maintained database. Hernias were graded according to the VHWG grading scale, and patients were evaluated for the incidence of a SSO. The relationships between comorbidities, hernia defect characteristics, CDC wound classification, and SSOs were also evaluated. RESULTS: There were 299 patients who met inclusion criteria and were available for follow-up. Surgical site occurrence was identified in 14% grade 1, 29% grade 2, 38% grade 3, and 49% grade 4 patients (p = 0.003). However, grade 3 patients with only a previous wound infection had a significantly different incidence of SSO than those with a violation of the gastrointestinal (GI) tract and were actually more similar to grade 2 patients. Likewise, violation of the GI tract had a similar rate of SSO to grade 4 patients. Finally, CDC wound classification also accurately predicted SSO across all levels of contamination. CONCLUSIONS: Modification of the VHWG grading scale into a 3-level grading system would significantly improve the accuracy of predicting SSO after open ventral hernia repair. Grade 2 patients should include those with comorbidities and previous wound infections. Grade 3 patients should be stratified based on CDC definitions of wound contamination. This modified grading scale would significantly improve outcomes reporting after open ventral hernia repair.