An Observational Cohort Study on Non-Recurrence Procedural Intervention and Reoperation for Recurrence After Ventral Hernia Repair

Objective: To establish the use of Non-Recurrence Procedural Intervention (NRPI) and Reoperation for Recurrence (ROR) as long-term outcome measures after ventral hernia repair (VHR). NRPI is a novel, claims-based measure sensitive to procedures performed to manage complications after VHR. Summary Background Data: Obtaining long-term follow-up after VHR is difficult. Clinical registry linkages with administrative claims data offer a novel solution to assess long-term complications and recurrence. This study provides validation of coding algorithms for these outcomes to ensure reproducibility and scalability. Methods: This was an observational cohort study of patients undergoing VHR from 2011-2019 at a single tertiary care center. Claims-based coding algorithms for NRPI and ROR were compared to abstracted electronic health record (EHR) information. The main outcome was cumulative incidence of long-term NRPI and ROR. P <0.007 was significant using Bonferroni adjustment. Results: 1,229 patients were identified (50% female, 80% white race). Forty-three percent underwent minimally invasive VHR. Median hernia width was 3 cm (IQR 2 cm-6 cm). Median follow-up was 4.5 years for adminstrative and EHR data. The cumulative incidence of NRPI remained similar for claims 7.17% (95%CI 5.73-8.62%) and EHR 5.54% (95%CI 4.26-6.82%), P =0.0184. Similar results were found for ROR: claims 6.84% (95%CI 5.43-8.25%) and EHR 7.00% (95%CI 5.58-8.43%), P =0.6547. Conclusions: NRPI and ROR cumulative incidence rates are similar using the claims-based coding algorithm and EHR data. The algorithm can be used to enhance long-term follow-up through clinical registry linkages with administrative claims data. This will enable robust long-term assessment for research, quality improvement, and post-market device surveillance.