Incisional Hernia After Liver Transplant: A Population-Level Retrospective Cohort Analysis

INTRODUCTION: Incisional hernia is a common complication of liver transplant. However, the incidence of incisional hernia following liver transplant in a contemporary national cohort remains to be explored. MATERIALS AND METHODS: We used 100% fee-for-service Medicare claims to develop a retrospective cohort of beneficiaries who underwent liver transplant between 2016 and 2021. We estimated the cumulative incidence of incisional hernia repair, regarded as a four-fold undercount of true hernia incidence, and evaluated the variation across transplant centers using risk- and reliability-adjusted models accounting for beneficiary demographics, comorbidities, and year of liver transplant. RESULTS: The study cohort included 14,417 beneficiaries. The 5-y beneficiary-level risk-adjusted cumulative incidence of incisional hernia repair was 6.8% (confidence interval: 6.2-7.3), corresponding to a 27.2% incidence of incisional hernia. The 5-y transplant center-level incidence rate of incisional hernia repair varied 2.8-fold, from 2.9% at the transplant center with the lowest incidence rate to 8.3% at the transplant center with the highest incidence rate. CONCLUSIONS: Incisional hernia remains a common complication of liver transplant with variation across transplant centers suggesting that there are opportunities for quality improvement efforts to identify best practices at transplant centers with comparatively low incidence of incisional hernia following liver transplant.