Reoperation Versus Self‐Reported Recurrence After Ventral Hernia Repair: A Nationwide Survey‐ and Register‐Based Study

ABSTRACT Background Reoperation is often used as an outcome measure after ventral hernia repair but may underestimate the true recurrence rate, potentially leading to biased interpretation of studies using reoperation for recurrence as an outcome. This study aimed to determine the proportion of patients with recurrence after ventral hernia repair who undergo reoperation for recurrence in a nationwide population. Methods This nationwide survey‐ and register‐based study, part of the AFTERHERNIA Project, included patients ≥ 18 years undergoing primary ventral or incisional hernia repair between January 2014 and March 2024. Patients were identified in the Danish National Patient Register and invited to participate in an electronic survey. Survey responses were linked to the Danish Ventral Hernia Database. Recurrence was defined as either reoperation for recurrence or self‐reported recurrence. Prevalences were estimated and adjusted for using regression analyses with marginal standardization. Results A total of 20,703 patients were included (16,904 primary ventral and 3799 incisional hernias; 80% response rate), with a median follow‐up of 5.5 years. Among primary ventral hernias, overall recurrence was 15.5% (95% CI, 15.0–16.1), of which 3.3% (95% CI, 3.1–3.6) had a reoperation and 12.2% (95% CI, 11.7–12.7) had self‐reported recurrence. Among incisional hernias, overall recurrence was 27.2% (95% CI, 25.8–28.6), of which 7.0% (95% CI, 6.3–7.7) had a reoperation and 20.2% (95% CI, 18.9–21.5) had self‐reported recurrence. Conclusion The prevalence of reoperation for recurrence underestimated the overall prevalence of recurrence by approximately fivefold after primary ventral hernia repair and fourfold after incisional hernia repair.