Incisional Hernias After Major Abdominal Operations: Analysis Within a Large Health Care System Jenny M. Shao, MD, Yewande Alimi, MD, MHS, Brenna K. Houlihan, MD, Anne Fabrizio, MD, Mohammed Bayasi, MD, and Parag Bhanot, MD* Department of Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia article info Article history: Received 29 August 2019 Received in revised form 22 November 2019 Accepted 6 December 2019 Available online xxx Keywords: Incisional hernia Colectomy Pancreatectomy Gastrectomy Hepatectomy Malignancy abstract Background: This will be the largest multi-institutional study looking at incidence of and duration to symptomatic hernia formation for major abdominal operations separated by malignant and benign disease process. Methods: An IRB-approved retrospective study within the MedStar Hospital database was conducted, incorporating all isolated colectomy, hepatectomy, pancreatectomy, and gas- trectomy procedures between the years 2002 and 2016. All patients were identified using ICD-9 and ICD-10 codes for relevant procedures, and then separated based on malignant or benign etiology. The rate of symptomatic incisional hernia rates was determined for each cohort based on subsequent hernia procedural codes identified. Results: During this 15-year span, a total of 6448 major abdominal operations were per- formed at all 10 institutions, comprising 3835 colectomies, 1122 hepatectomies, 1165 pancreatectomies, and 326 gastrectomies. Total incidence of symptomatic incisional her- nia occurrence requiring repair was 325 (5.0%). Separated by group, the overall incisional hernia repair rates for patients undergoing colectomy, hepatectomy, pancreatectomy, and gastrectomy are as follows, respectively: 6.4% (247), 2.5% (28), 3.6% (42), and 2.8% (9), P < 0.0001. The subsequent median duration to hernia repair was 498 d (interquartile range [IQR]: 312-924) for colectomy, 421 d (IQR: 340-518) for hepatectomy, 378 d (IQR: 284-527) for pancreatectomy, and 630 d (IQR: 419-1204) for gastrectomy (P ¼ 0.03401). Conclusions: Symptomatic incisional hernia repair rates after major gastrointestinal and hepatobiliary surgery range from 2.1% to 6.4%. There was no significant increase in hernia rates in patients undergoing surgery for malignancy. ª 2019 Elsevier Inc. All rights reserved. Introduction Incisional hernias remain one of the most common compli- cations after abdominal surgery. The rate of incisional hernia occurrence is highly variable depending on a variety of sur- gical and patient factors and has been quoted to be between 5% and 20%. 1-4 These complications not only decrease quality of life for patients from a psychosocial and physical stand- point 5-7 but can also result in incarceration, bowel obstruc- tions, and need for emergency surgery, which ultimately leads to an increase in hospitalizations and health care utilization. Decreasing the incidence of incisional hernias is not only * Corresponding author. Department of General Surgery, 3800 Reservoir Road NW, Washington, DC 20007. Tel.: þ1 703 635 5545; fax: (877) 376-2418. E-mail address: pxb129@gunet.georgetown.edu (P. Bhanot). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research  may 2020 (249) 130 e137 0022-4804/$ e see front matter ª 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jss.2019.12.016