Frequency and Predictors of Postoperative Fluid Collections (POFC) in Patients Following Ventral Hernia Repair with Mesh Implants

Background: This study aimed to identify risk indicators for fluid accumulation after ventral hernia repair and to develop a prognostic model for postoperative fluid collections in the implantation area. Methods and Results: A retrospective analysis was conducted on the medical records of 214 patients who underwent VHR. Postoperative complications following surgical intervention were analyzed. In this study, cases of POFC in the area of mesh implantation following VHR with synthetic mesh materials were analyzed. POFC was operationally defined as sterile, non-infected fluid accumulations detected in the postoperative period by ultrasound examination, characterized by the absence of clinical signs of inflammation, redness, fever, or infection. The incidence of persistent POFC in the study cohort was 23(10.7%) out of 214 patients. A univariate analysis of the association between the presence of POFC and preoperative laboratory parameters showed statistically significant differences between the study groups for neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), and albumin level. The analysis of the association between postoperative Day 1 laboratory parameters and the development of POFC showed that among the analyzed laboratory parameters, a statistically significant difference between patients with and without POFC was identified for total protein level. On postoperative Day 5, statistically significant differences between patients with and without POFC were observed for hemoglobin and total protein levels, suggesting a potential role of protein metabolism and blood oxygen transport function in the pathogenesis of persistent fluid collection formation. A multivariate statistical analysis using binary logistic regression identified significant predictors of POFC development in the postoperative period: hernia defect diameter (AOR: 1.143; 95% CI: 1.042–1.254; P=0.005), NLR (AOR: 1.596; 95% CI: 1.235–2.063; P<0.001), and the presence of ischemic heart disease (AOR: 10.275; 95% CI: 2.801–37.675; P<0.001). The prognostic model demonstrated good discriminatory ability, with an AUC of 0.87 (95% CI: 0.775–0.966; P<0.001), sensitivity of 82.6%, and specificity of 81.7%. Conclusion: The results obtained confirm a significant association between the anatomical characteristics of the hernia defect, the presence of cardiovascular pathology, the systemic inflammatory response, and the risk of persistent postoperative fluid accumulation. A nomogram based on the obtained logistic regression model was created, enabling the prediction of the likelihood of developing this complication.