Preoperative Forced Expiratory Volume in One Second as an Independent Predictor of Inguinal Hernia Recurrence: A Retrospective Cohort Study

Background: Inguinal hernia repair is one of the most performed surgical procedures worldwide. Despite advances in technique, recurrence remains a significant clinical concern. While factors such as smoking and chronic pulmonary disease have been implicated, the prognostic value of objective pulmonary function parameters remains unclear. Aim: This study evaluated whether preoperative forced expiratory volume in one second (FEV 1 ) is associated with recurrence after inguinal hernia repair. Methods: A retrospective cohort study was conducted on patients who underwent hernia repair at a regional teaching hospital in northern Taiwan between 2011 and 2017. Preoperative pulmonary function test results and long-term recurrence outcomes were analyzed. Cox proportional hazards models were used to evaluate the association between FEV 1 and recurrence. Receiver operating characteristic (ROC) analysis and Kaplan–Meier survival analysis were performed for risk stratification. Results: Among the 89 eligible patients (mean age: 74.18 ± 12.68 years), 18 (20.2%) developed recurrence during a median follow-up of 50 months. In multivariable Cox analysis, FEV 1 (% predicted) was independently associated with recurrence (hazard ratio: 0.965 per 1% increase; 95% confidence interval: 0.937–0.994, P = 0.018). ROC analysis identified an optimal cutoff of 74.21%, and Kaplan–Meier analysis demonstrated significant recurrence-free survival stratification based on this threshold (log-rank P = 0.002). Conclusion: Reduced preoperative FEV 1 was significantly associated with an increased hazard of recurrence following inguinal hernia repair. These findings suggest that objective pulmonary function assessment may provide incremental prognostic information, although larger prospective studies are needed to confirm these results.