The Components Separation Technique Increases 30-Day Adverse Outcomes in Patients Undergoing Anterior Abdominal Hernia Repair With Medium to Large Defects

Background Components separation techniques (CST) for anterior abdominal hernia repair (AAHR) are utilized to facilitate midline closure, reduce hernia recurrences, and avoid bridging mesh. New CPT ® codes for AAHR allow differentiation of the impact of CST on AAHR outcomes, accounting for defect size. Methods We selected electively performed >3 cm AAHRs from the 2023 ACS NSQIP files. We examined the influence on NSQIP 30-day outcomes of CST (CPT 15734) with and without adjustment for defect size and NSQIP risk variables. Results In 24 478 elective >3 cm defect AAHRs, 2227 patients (9.1%) underwent CST. CST is more common in open approach [5.4% vs 13.2% ( P < .001)], large defects [3.6% vs 26.4% ( P < .001)], recurrent hernias [.4% vs 17.3% ( P < .001)], and incarcerated repairs [7.3% to 11.5% ( P < .001)]. CST increased AAHR-adjusted operative time by 75 min in laparoscopic and 68 min in open procedures ( P < .001). Major morbidity increased from 4.4% to 11.8% ( P < .001) in CST patients, and SSI increased from 2.5% to 6.0% ( P < .001). With risk adjustment, CST odds ratio for morbidity was 1.38 [95% CI 1.16-1.63, P < .001] and SSI was 1.22 [95% CI 0.97-1.53, P = .083]. The use of CST increased reoperation from 1.6% to 2.8% ( P < .001), readmission from 3.5% to 7.0% ( P < .001), and 30-day mortality from 0.2% to 0.5% ( P = .003). Hospital stay increased by 1.2 days ( P < .001). Conclusion Ventral hernia repair with CST is associated with significantly increased 30-day adverse outcomes compared to repairs without CST in hernias of all sizes.