Influence of complications on patient-reported outcome measures in 5,312 prospectively registered abdominal wall reconstructions using propensity score matching

BACKGROUND: Patient-reported outcome measures provide essential insight into postoperative recovery, yet the impact of specific complications on patient-reported domains after incisional hernia repair remains poorly understood. METHODS: Patients who underwent incisional hernia repair between 2011 and 2025 were identified from the French Hernia-Club registry. All complications were recorded within 30 days postoperatively. Those with surgical site infections, surgical site occurrences, or occurrences requiring procedural intervention (Clavien-Dindo grade III) were propensity score matched to controls without complications. Repeated measures regression models assessed associations between complication type and pain (visual analog scale), analgesic use, postoperative discomfort, functional outcomes, and limitations in daily life. RESULTS: A total of 5,312 patients were analyzed (surgical site infection n = 185; surgical site occurrence n = 409; surgical site occurrence requiring procedural intervention n = 222). Surgical site infections were associated with higher pain intensity (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.53-1.83, P < .001), more postoperative discomfort (OR 4.21, 95% CI 1.31-13.5, P = .016), worse functional outcomes (OR 0.45, 95% CI 0.32-0.65, P < .001), and greater limitations in daily life (OR 2.60, 95% CI 1.74-3.89, P < .001). Surgical site occurrences showed increased pain (OR 1.17, 95% CI 1.10-1.25, P < .001), more discomfort (OR 2.61, 95% CI 1.34-5.09, P < .001), and worse function (OR 0.54, 95% CI 0.45-0.62, P < .001). Surgical site occurrences requiring procedural interventions were associated with higher pain scores (OR 1.24, 95% CI 1.11-1.39, P < .001), greater discomfort (OR 5.39, 95% CI 1.34-21.6, P < .001), worse function (OR 0.31, 95% CI 0.23-0.42, P < .001), and increased limitations in daily life (OR 2.40, 95% CI 1.59-3.61, P < .001). Although patient-reported outcome measures improved over time, they remained worse than controls. CONCLUSION: Postoperative complications after incisional hernia repair are independently associated with worse patient-reported outcomes. However, differences between surgical site infection, surgical site occurrence, and surgical site occurrence requiring procedural intervention are modest, and all complication types show broadly similar detrimental effects. These findings highlight the importance of incorporating complication-specific patient-reported outcome measure data into quality improvement and patient counseling.