Trunk muscle strength assessment as a predictor of complications in patients undergoing incisional hernia repair

Incisional hernia is a common condition with significant complication rates. While various risk factors have been studied, the role of preoperative trunk muscle strength in predicting postoperative outcomes remains underexplored. This is a prospective cohort study conducted with 75 patients undergoing incisional hernia repair between 1st June 2022 to 31st September 2024. Preoperative trunk muscle strength was assessed by using a strain gauge device, targeting both medial and lateral abdominal muscle groups, and recording force peak (FP) and rate force development (RFD). Patients were followed for 30 days postoperatively, and complications were classified using the Clavien-Dindo classification. Associations between muscle strength and postoperative outcomes, anthropometric variables and comorbidities were analyzed. Mean age was 57.6 years and mean BMI 29.19 kg/m2. Complications were observed in 32% of patients. Sex-related differences were found: men exhibited greater anterior trunk strength (FP90° 193.8 vs 147.4 N, p < 0.003; RFD90° 667 vs 400.9 N/s, p < 0.03). Postoperative bleeding was associated with lateral trunk strength (FP45° 96.0 vs 154.2 N; p < 0.042), and surgical site infection was correlated with anterior strength in male patients (FP90° 149.7 vs 203.8 N; p < 0.03). No significant association was found between bleeding and antiplatelet or anticoagulant therapy. Preoperative trunk muscle strength may serve as a useful predictor of postoperative complications in patients undergoing incisional hernia repair. These findings support the potential role of targeted pre-habilitation strategies, in order to improve surgical outcomes.