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Introduction: Preoperative frailty is a strong predictor of postoperative morbidity in the general surgery population. Despite this, there are a paucity of research examining the effect of frailty on outcomes after ventral hernia repair (VHR), one of the most common abdominal operations in the USA. We examined the association of frailty with short-term postoperative outcomes while accounting for differences in preoperative, operative, and hernia characteristics., Methods: We retrospectively reviewed the Michigan Surgery Quality Collaborative Hernia Registry (MSQC-HR) for adult patients who underwent VHR between January 2020 and January 2022. Patient frailty was assessed using the validated 5-factor modified frailty index (mFI5) and categorized as follows: no (mFI5 = 0), moderate (mFI5 = 1), and severe frailty (mFI5 ≥ 2). Our primary outcome was any 30-day complication. Multivariable logistic regression was used to evaluate the association of frailty with outcomes while controlling for patient, operative, and hernia variables., Results: A total of 4406 patients underwent VHR with a mean age (SD) of 55 (15) years, 2015 (46%) females, and 3591 (82%) white patients. The mean (SD) BMI of the cohort was 33 (8) kg/m2. A total of 2077 (47%) patients had no frailty, 1604 (36%) were moderately frail, and 725 (17%) were severely frail. The median hernia size (interquartile range) was 2.5 cm (1.5-4.0 cm). Severe frailty was associated with increased odds of any complication (adjusted Odds Ratio (aOR) 3.12, 95% CI 1.78-5.47), serious complication (aOR 5.25, 95% CI 2.17-13.19), SSI (aOR 3.41, 95% CI 1.58-7.34), and post-discharge adverse events (aOR 1.70, 95% CI 1.24-2.33)., Conclusion: After controlling for patient, operative, and hernia characteristics, frailty was independently associated with increased odds of postoperative complications. These findings highlight the importance of preoperative frailty assessment for risk stratification and to inform patient counseling., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Operative technique for hernias < 2 cm is highly controversial. Limited data exist about this practice at a population level. Within this context we sought to describe practice patterns and use of mesh among patients undergoing repair of small hernias within the setting of a statewide quality improvement collaborative., Methods: Retrospective cohort study of patients undergoing hernia repair in the Michigan Surgical Quality Collaborative Hernia Registry was conducted. Patients who underwent repair of a hernia < 2 cm from January 1, 2020 to July 8, 2021 were included. Descriptive statistics were performed to describe cohort characteristics and compare patients who did and did not receive mesh. Logistic regression was performed to estimate the odds of receiving mesh after accounting for patient and hernia characteristics., Results: Among 570 patients, 56.1% (n = 320) had mesh placed. Most repairs were conducted via open approach (n = 437, 76.5%). Patients who received mesh were older (51.8 vs 48.6, p < 0.01), had higher BMI (31.7 vs 30.0, p < 0.01), were more often ASA Class III (35.9% vs 24.4%, p < 0.01), more often had diabetes (15.9% vs 10.0%, 0.04) and hypertension (44.7% vs 30.4%, p < 0.01), and had higher hernia width (1.2 cm vs 1.0 cm, p < 0.0001). After adjustment, ASA Class III (aOR 3.41, 95% CI 1.31-8.89), current smoking status (aOR 1.81, 95% CI 1.04-3.18), higher mean hernia width (aOR 5.68, 95% CI 2.97-10.85), and laparoscopic (aOR 12.9, 95% CI 5.02-32.96) or robotic (aOR 24.3, 95% CI 6.96-84.96) were associated with mesh use, while COPD (aOR 0.36, 95% CI 0.07-0.96) was associated with less mesh use., Conclusions: Use of mesh for small hernias remains controversial. We found that patients who had mesh placed at the time of surgery were potentially patients at higher risk for complications. The decision to use mesh may be driven by patient-related factors that predispose to complications and operative recurrence rather than evidence indicating that it is superior in this population., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Variable approaches to intraoperative communication impede our understanding of surgical decision-making and best practices. This is critical among hernia repairs, where improved outcomes are reliant on understanding the impact of different patient characteristics and surgical approaches. In this context, a hernia-specific synoptic operative note was piloted as part of an effort to create a statewide hernia registry. We aimed to understand the impact of the synoptic operative note on variable missingness and evaluate barriers and facilitators to improved intraoperative communication and note adoption., Methods: In January 2020, the Michigan Surgical Quality Collaborative (MSQC) registry was expanded to capture hernia-specific intraoperative variables. A synoptic operative note for hernia repair was piloted at 8 hospitals. The primary outcome was change in hernia variable communication, measured by missingness. Using a sequential explanatory mixed-methods design, we performed semi-structured interviews with data abstractors (n = 4) and surgeons (n = 4) at 5 pilot sites to assess barriers and facilitators of implementation. Interviews were iteratively analyzed using content analysis with both deductive and inductive approaches., Results: From January to June 2020, 870 hernia repairs were performed across 8 pilot and 53 control sites. Pilot sites had significantly less missingness for all hernia-specific variables. At pilot sites, 46% of notes were fully complete in regard to hernia variables, compared to 21% at control sites (p value < 0.001). While collection of intraoperative variables improved after synoptic note implementation, low note adoption was reported. Facilitators of improved variable collection were (1) communication with data abstractors and (2) stakeholder acknowledgment of widespread benefit, while barriers included (1) surgeon resistance to practice change, (2) EMR/technology, and (3) interruptions to communication and implementation., Conclusion: This mixed-methods evaluation of a synoptic operative note implementation suggests that sustained communication, particularly with abstractors, was the most impactful intervention. Future implementation efforts may have improved effectiveness with interventions supplementary to surgeon-level direction., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)