Skip to main content
SpringerLink
Log in

The enigma of incisional hernia prediction unraveled: external validation of a prognostic model in colorectal cancer patients

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

Accurate prediction of hernia occurrence is vital for surgical decision-making and patient management, particularly in colorectal surgery patients. While a hernia prediction model has been developed, its performance in external populations remain to be investigated. This study aims to validate the existing model on an external dataset of patients who underwent colorectal surgery.

Methods

The “Penn Hernia Calculator” model was externally validated using the Hughes Abdominal Repair Trial (HART) data, a randomized trial comparing colorectal cancer surgery closure techniques. The data encompassed demographics, comorbidities, and surgical specifics. Patients without complete follow-up were omitted. Model performance was assessed using key metrics, including area under the curve (AUC-ROC and AUC-PR) and Brier score. Reporting followed the TRIPOD consensus.

Results

An external international dataset consisting of 802 colorectal surgery patients were identified, of which 674 patients with up to 2 years follow-up were included. Average patient age was 68 years, with 63.8% male. The average BMI was 28.1. Prevalence of diabetes, hypertension, and smoking were 15.7%, 16.3%, and 36.5%, respectively. Additionally, 7.9% of patients had a previous hernia. The most common operation types were low anterior resection (35.3%) and right hemicolectomy (34.4%). Hernia were observed in 24% of cases by 2-year follow-up. The external validation model revealed an AUC-ROC of 0.66, AUC-PR of 0.72, and a Brier score of 0.2.

Conclusion

The hernia prediction model demonstrated moderate performance in the external validation. Its potential generalizability, specifically in those undergoing colorectal surgery, may suggest utility in identifying and managing high-risk hernia candidates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Data available on request from the authors.

References

  1. Bosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A et al (2015) Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PLoS ONE 10:e0138745. https://doi.org/10.1371/journal.pone.0138745

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Collaborative H (2022) Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 109:943–950. https://doi.org/10.1093/bjs/znac198

    Article  Google Scholar 

  3. van Ramshorst GH, Eker HH, Hop WC, Jeekel J, Lange JF (2012) Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg 204:144–150. https://doi.org/10.1016/j.amjsurg.2012.01.012

    Article  PubMed  Google Scholar 

  4. Gignoux B, Bayon Y, Martin D, Phan R, Augusto V, Darnis B, Sarazin M (2021) Incidence and risk factors for incisional hernia and recurrence: retrospective analysis of the French national database. Colorectal Dis 23:1515–1523. https://doi.org/10.1111/codi.15581

    Article  PubMed  Google Scholar 

  5. Holihan JL, Alawadi Z, Martindale RG, Roth JS, Wray CJ, Ko TC et al (2015) Adverse events after ventral hernia repair: the vicious cycle of complications. J Am Coll Surg 221:478–485. https://doi.org/10.1016/j.jamcollsurg.2015.04.026

    Article  PubMed  Google Scholar 

  6. Bower C, Roth JS (2013) Economics of abdominal wall reconstruction. Surg Clin N Am 93:1241–1253. https://doi.org/10.1016/j.suc.2013.06.007

    Article  PubMed  Google Scholar 

  7. Gillion JF, Sanders D, Miserez M, Muysoms F (2016) The economic burden of incisional ventral hernia repair: a multicentric cost analysis. Hernia 20:819–830. https://doi.org/10.1007/s10029-016-1480-z

    Article  PubMed  Google Scholar 

  8. Xi Y, Xu P (2021) Global colorectal cancer burden in 2020 and projections to 2040. Transl Oncol 14:101174. https://doi.org/10.1016/j.tranon.2021.101174

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shinji S, Yamada T, Matsuda A, Sonoda H, Ohta R, Iwai T et al (2022) Recent advances in the treatment of colorectal cancer: a review. J Nippon Med Sch 89:246–254. https://doi.org/10.1272/jnms.JNMS.2022_89-310

    Article  CAS  PubMed  Google Scholar 

  10. Basta MN, Kozak GM, Broach RB, Messa CA, Rhemtulla I, DeMatteo RP et al (2019) Can we predict incisional hernia?: Development of a surgery-specific decision-support interface. Ann Surg 270:544–553. https://doi.org/10.1097/sla.0000000000003472

    Article  PubMed  Google Scholar 

  11. Morris EJ, Forman D, Thomas JD, Quirke P, Taylor EF, Fairley L et al (2010) Surgical management and outcomes of colorectal cancer liver metastases. Br J Surg 97:1110–1118. https://doi.org/10.1002/bjs.7032

    Article  CAS  PubMed  Google Scholar 

  12. den Hartog FPJ, van Egmond S, Poelman MM, Menon AG, Kleinrensink GJ, Lange JF et al (2023) The incidence of extraction site incisional hernia after minimally invasive colorectal surgery: a systematic review and meta-analysis. Colorectal Dis 25:586–599. https://doi.org/10.1111/codi.16455

    Article  Google Scholar 

  13. Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J et al (2015) Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 386:1254–1260. https://doi.org/10.1016/s0140-6736(15)60459-7

    Article  PubMed  Google Scholar 

  14. Sajid MS, Parampalli U, Baig MK, McFall MR (2011) A systematic review on the effectiveness of slowly-absorbable versus non-absorbable sutures for abdominal fascial closure following laparotomy. Int J Surg 9:615–625. https://doi.org/10.1016/j.ijsu.2011.09.006

    Article  CAS  PubMed  Google Scholar 

  15. Deerenberg EB, Henriksen NA, Antoniou GA, Antoniou SA, Bramer WM, Fischer JP et al (2022) Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies. Br J Surg 109:1239–1250. https://doi.org/10.1093/bjs/znac302

    Article  PubMed  PubMed Central  Google Scholar 

  16. Henriksen NA, Deerenberg EB, Venclauskas L, Fortelny RH, Miserez M, Muysoms FE (2018) Meta-analysis on materials and techniques for laparotomy closure: the MATCH review. World J Surg 42:1666–1678. https://doi.org/10.1007/s00268-017-4393-9

    Article  CAS  PubMed  Google Scholar 

  17. Höer J, Lawong G, Klinge U, Schumpelick V (2002) Einflussfaktoren der Narbenhernienentstehung Retrospektive Untersuchung an 2.983 laparotomierten Patienten über einen Zeitraum von 10 Jahren. Chirurg 73:474–480. https://doi.org/10.1007/s00104-002-0425-5

    Article  PubMed  Google Scholar 

  18. Sørensen LT, Hemmingsen UB, Kirkeby LT, Kallehave F, Jørgensen LN (2005) Smoking is a risk factor for incisional hernia. Arch Surg 140:119–123. https://doi.org/10.1001/archsurg.140.2.119

    Article  PubMed  Google Scholar 

  19. Jairam AP, Timmermans L, Eker HH, Pierik R, van Klaveren D, Steyerberg EW et al (2017) Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet 390:567–576. https://doi.org/10.1016/s0140-6736(17)31332-6

    Article  PubMed  Google Scholar 

  20. Collins GS, Reitsma JB, Altman DG, Moons KG (2015) Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMJ 350:g7594. https://doi.org/10.1136/bmj.g7594

    Article  PubMed  Google Scholar 

  21. Moons KG, Kengne AP, Grobbee DE, Royston P, Vergouwe Y, Altman DG, Woodward M (2012) Risk prediction models: II. External validation, model updating, and impact assessment. Heart 98:691–698. https://doi.org/10.1136/heartjnl-2011-301247

    Article  PubMed  Google Scholar 

  22. Altman DG, Vergouwe Y, Royston P, Moons KG (2009) Prognosis and prognostic research: validating a prognostic model. BMJ 338:b605. https://doi.org/10.1136/bmj.b605

    Article  PubMed  Google Scholar 

  23. McAuliffe PB, Hsu JY, Broach RB, Borovskiy Y, Christopher AN, Morris MP, Fischer JP (2022) Systematic variable reduction for simplification of incisional hernia risk prediction instruments. Am J Surg 224:576–583. https://doi.org/10.1016/j.amjsurg.2022.03.003

    Article  PubMed  Google Scholar 

  24. Aiolfi A, Cavalli M, Gambero F, Mini E, Lombardo F, Gordini L et al (2023) Prophylactic mesh reinforcement for midline incisional hernia prevention: systematic review and updated meta-analysis of randomized controlled trials. Hernia 27:213–224. https://doi.org/10.1007/s10029-022-02660-4

    Article  CAS  PubMed  Google Scholar 

  25. Calaluce R, Davis JW, Bachman SL, Gubin MM, Brown JA, Magee JD et al (2013) Incisional hernia recurrence through genomic profiling: a pilot study. Hernia 17:193–202. https://doi.org/10.1007/s10029-012-0923-4

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. C. Amro and L. Smith contributed equally to this work.

Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14t Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    C. Amro, J. Shulkin, J. R. McGraw, R. B. Broach & J. P. Fischer

  2. Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK

    L. Smith & J. Torkington

  3. School of Medicine, Cardiff University, Cardiff, UK

    L. Smith & N. Hill

Authors
  1. C. Amro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Shulkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. R. McGraw
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Hill
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. B. Broach
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Torkington
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. P. Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Amro.

Ethics declarations

Ethical approval, Human and animal rights and Informed consent

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Data collected was granted UK NHS Research Ethics Committee (REC) approval by Wales REC 3 (ref 12/WA/0374). Participants consented to the use of anonymized information for research purposes.

Conflict of interest

Dr. Fischer has received consulting payments from 3 M, AbbVie, Baxter, Becton-Dickson, WL Gore, and Integra Life Sciences. He has received research support from the National Institutes of Health (NIH). Dr. Torkington has acted as a consultant on commercial trials of mesh in incisional hernia prevention for Medtronic. The other authors have no disclosures. No support was provided for this work.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Amro, C., Smith, L., Shulkin, J. et al. The enigma of incisional hernia prediction unraveled: external validation of a prognostic model in colorectal cancer patients. Hernia 28, 547–553 (2024). https://doi.org/10.1007/s10029-023-02947-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-023-02947-0

Keywords

Search

Navigation