Postoperative complication burden after ventral hernia repair stratified by modified ventral hernia working group grade: a claims-based cohort study.

PURPOSE: The modified Ventral Hernia Working Group (mVHWG) classification stratifies patients by risk for complications; however, real-world evidence quantifying complication burden across mVHWG grades remains limited. This study developed and applied a claims-based algorithm to approximate the mVHWG classification and assess variations in postoperative complication burden by mVHWG grade.

METHODS

A retrospective cohort study was conducted using MarketScan®. Adults undergoing VHR between January 2021 and December 2024 were included if they had continuous enrollment for at least 12 months pre-procedure and 6 months post-procedure. Patients were classified into mVHWG Grades 1-3 using diagnosis and procedure codes. Postoperative complications within 6 months were identified using claims data. Incidence and number of complications per patient were assessed.

RESULTS

29,845 patients were included, classified as Grade 1 (44.4%), Grade 2 (44%), and Grade 3 (11.6%). Within 6 months, 17.2% experienced postoperative complications, with a significant stepwise increase in incidence by mVHWG grade (10.6%, 15.7% and 48.5% for Grades 1-3 respectively). The number of recorded complications per patient was higher with increased mVHWG grade.

CONCLUSION

This study operationalizes mVHWG classification in claims data and demonstrates an increase in complication burden across mVHWG grades following VHR, including higher incidence and greater number of complications per patient. Grade 2 patients represented a large proportion of the cohort and experience greater complication burden than Grade 1 patients, underscoring the importance of this risk group. Further research is warranted to validate the algorithm against clinically assigned mVHWG grades as well as to examine long-term outcomes and costs associated with early complications across mVHWG grades.