Is Nonoperative Management Warranted in Ventral Hernia Patients With Comorbidities?: A Case-matched, Prospective, Patient-centered Study

The aim of this study was to determine patient-centered outcomes of nonoperative treatment of a ventral hernia.Nonoperative management of ventral hernias (VHs) is often recommended for patients at increased risk of complications; however, the impact of this management strategy on outcome and quality of life (QoL) is unknown. We hypothesize that QoL and function are better among patients with VHs managed operatively.Patients with a VH from a single-center hernia clinic were prospectively enrolled between June 2014 and June 2015. Nonoperative management was recommended if smoking, obesity, or poorly controlled diabetes was present. Primary outcomes were patient-centered outcomes, including QoL and function, which were measured using a validated, hernia-specific survey (modified Activities Assessment Scale) before surgeon' consultation and at 6 months. Other outcomes included surgical site infection (SSI) and recurrence. Risk-adjusted outcomes between nonoperative and operative groups were compared using: paired t test on a propensity score-matched subset and multivariable analysis on the overall cohort.A total of 152 patients (nonoperative = 97, operative = 55) were enrolled. In the propensity-matched cohort (n = 90), both groups had similar baseline QoL and function scores, but only repaired patients had improved scores on 6-month follow-up. In the overall cohort, nonoperative management was strongly associated with lower function scores (log odds ratio = -26.5; 95% confidence interval = -35.0 to -18.0).This is the first prospective study comparing management strategies in VH patients with comorbidities. Elective repair improves hernia-related QoL and function in low- to moderate-risk patients and should be considered in appropriately selected patients.