Hernia repair is among the most frequently performed surgical procedures worldwide, with elective surgeries constituting a significant portion of general surgical workloads. Despite ongoing advancements in surgical techniques and perioperative management, postoperative complications remain a considerable concern, impacting patient recovery and healthcare systems alike. These complications may lead to prolonged hospitalization, increased healthcare costs, and diminished patient satisfaction [1,2].

The reported incidence of postoperative complications in hernia surgeries varies widely and is influenced by both patient- and procedure-related factors. Common complications include surgical site infections (SSI), seroma formation, urinary retention, and wound dehiscence [3]. The emergence of mesh-based techniques has improved outcomes in many cases, yet mesh-related complications—particularly infections—continue to be clinically significant [4].

Identifying high-risk patients before surgery is crucial for planning preventive strategies. Risk stratification based on parameters such as age, body mass index (BMI), diabetes mellitus, smoking history, and ASA (American Society of Anesthesiologists) physical status classification is increasingly emphasized in surgical decision-making [5]. However, there is a paucity of multicenter data focusing exclusively on predictors of postoperative complications in elective hernia repairs, especially in low- and middle-income healthcare settings.

Therefore, this study was conducted to evaluate the incidence and predictors of postoperative complications in patients undergoing elective hernia repair, with the aim of improving clinical outcomes through early identification and optimization of modifiable risk factors.

This multicenter observational study was conducted at the Government Medical College (GMC), Wanaparthy, over a period of eleven months from March 2024 to January 2025. The study aimed to identify predictors of postoperative complications in patients undergoing elective hernia repair.

Study Design and Setting

A prospective, observational design was employed. Data were collected from patients scheduled for elective hernia repair under general or regional anesthesia at the Department of General Surgery, GMC Wanaparthy.

Study Population

A total of 100 adult patients (aged ≥18 years) undergoing elective hernia surgery were included. Patients with all types of hernia (inguinal, umbilical, and incisional) were considered eligible.

Inclusion Criteria

Adults aged ≥18 years

Patients undergoing elective hernia repair

Willingness to provide written informed consent

Exclusion Criteria

Emergency hernia surgeries

Recurrent or strangulated hernias

Patients with incomplete medical records or follow-up

Immunocompromised individuals (e.g., HIV, cancer chemotherapy)

Data Collection

Baseline demographic and clinical data including age, sex, BMI, smoking history, comorbidities (e.g., diabetes, hypertension), and ASA physical status classification were recorded preoperatively. Type of hernia and surgical approach were documented. Postoperative outcomes were monitored during hospital stay and followed up for 30 days post-surgery.

Outcome Measures

The primary outcome was the occurrence of any postoperative complication (e.g., surgical site infection, urinary retention, seroma, wound dehiscence) within 30 days. Secondary outcomes included duration of hospital stay and need for readmission.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS version 26. Continuous variables were expressed as mean ± standard deviation and compared using the student’s t-test. Categorical variables were expressed as frequencies and percentages; associations were tested using the Chi-square test or Fisher’s exact test. Multivariate logistic regression was performed to identify independent predictors of postoperative complications. A p-value <0.05 was considered statistically significant.

Ethical Consideration

The study was approved by the Institutional Ethics Committee of GMC Wanaparthy. Written informed consent was obtained from all participants prior to inclusion.

A total of 100 patients undergoing elective hernia repair were included in the study. The mean age of the cohort was 52.6 ± 13.4 years, with a male predominance (74%) (Table 1).

Table 1: Demographic and Clinical Characteristics of Study Participants (N = 100)

The most frequently encountered hernia type was inguinal hernia (61%), followed by umbilical (21%) and incisional hernia (18%) (Table 2).

Table 2: Distribution of Hernia Types

Postoperative complications were observed in 23 patients (23%). The most common complication was surgical site infection (10%), followed by urinary retention (6%), seroma formation (4%), and wound dehiscence (3%) (Table 3).

Table 3: Postoperative Complications Observed

Univariate analysis revealed that age >60 years (p = 0.021), BMI >30 kg/m² (p = 0.034), presence of diabetes mellitus (p = 0.016), smoking history (p = 0.041), and ASA physical status grade ≥ III (p = 0.007) were significantly associated with the occurrence of postoperative complications (Table 4).

Table 4: Univariate Analysis of Risk Factors for Postoperative Complications

Multivariate logistic regression analysis identified diabetes mellitus (Odds Ratio [OR] = 3.21; 95% Confidence Interval [CI]: 1.12–9.14; p = 0.029) and ASA grade ≥ III (OR = 4.17; 95% CI: 1.36–12.76; p = 0.012) as independent predictors of postoperative complications (Table 5).

Table 5: Multivariate Logistic Regression Analysis for Independent Predictors

Patients who developed complications had a significantly longer mean hospital stay (5.6 ± 2.1 days) compared to those without complications (2.8 ± 1.3 days, p < 0.001). No mortality was reported during the 30-day postoperative follow-up period.

This observational study conducted at Government Medical College, Wanaparthy, over an eleven-month period, aimed to evaluate the incidence and predictors of postoperative complications in patients undergoing elective hernia repair. The study revealed a 23% complication rate, which is consistent with findings from similar investigations, where postoperative complication rates following hernia repair range from 15% to 30%, influenced by surgical approach, patient risk profile, and perioperative protocols [6,10].

Among the complications observed, surgical site infections (SSI) were the most common (10%), followed by urinary retention (6%), seroma formation (4%), and wound dehiscence (3%). These findings are supported by previous studies highlighting SSI as the predominant postoperative complication in hernia repair procedures [7,8]. Mesh-related SSIs are of particular concern, especially when synthetic mesh is used in contaminated or high-risk patients, and require careful intraoperative handling and postoperative surveillance [9,11].

Univariate analysis identified advanced age (>60 years), BMI >30 kg/m², diabetes mellitus, smoking, and ASA grade ≥ III as significant predictors of postoperative complications. Notably, multivariate analysis demonstrated that diabetes mellitus and high ASA grade were independent predictors. These findings echo those of Quiroga-Centeno et al. and Jakob et al., who emphasized the role of systemic comorbidities and impaired host immunity in increasing the risk of SSI and other complications post-hernia repair [6,11].

Moreover, patients who developed complications experienced a significantly longer hospital stay, underlining the clinical and economic impact of adverse postoperative events. This is consistent with the work of van Hout et al., who also reported that complication surveillance—even via digital applications—can provide early intervention opportunities and reduce prolonged admissions [10].

The absence of 30-day postoperative mortality in this cohort may be attributed to the elective nature of the surgeries and timely perioperative optimization. These results underscore the critical role of preoperative risk stratification, particularly in diabetic patients and those with elevated ASA scores. Proactive optimization, including glycemic control, nutritional support, and targeted antibiotic prophylaxis, may reduce complication rates and improve surgical outcomes [6–11].

Although our study was limited by a modest sample size and single-center data collection, the results are clinically relevant and contribute valuable insights into perioperative risk management for hernia surgery.

This observational study identified a 23% incidence of postoperative complications following elective hernia repair, with surgical site infection being the most common. Age over 60, high BMI, diabetes mellitus, smoking, and higher ASA physical status were significantly associated with increased risk of complications. On multivariate analysis, diabetes mellitus and ASA grade ≥ III were found to be independent predictors. These findings highlight the need for thorough preoperative assessment and optimization of modifiable risk factors, particularly glycemic control and overall physical status. Incorporating these predictors into surgical planning may enhance patient safety, reduce postoperative morbidity, and shorten hospital stay in elective hernia surgery cases.

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