Predictors of Postoperative Complications After Retromuscular Incisional Hernia Repair: A Retrospective Cohort Study

Background: Incisional hernias are a frequent complication after abdominal surgery and may significantly affect patient outcomes. Retromuscular mesh placement using the Rives–Stoppa technique is widely considered a reliable approach for abdominal wall reconstruction, although postoperative complications remain an important clinical concern. Identifying predictors of adverse outcomes may improve patient selection and perioperative management. Methods: This retrospective cohort study included 1262 patients who underwent retromuscular incisional hernia repair. Demographic characteristics, comorbidities, hernia features, operative data, and postoperative outcomes were analyzed. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of postoperative complications. Model performance was evaluated using receiver operating characteristic analysis. Results: The study included 1262 patients with a mean age of 61.5 ± 12.4 years, with a slight predominance of women (55%). The overall complication rate was 19.5%, with seroma (10.5%), surgical site infection (7.0%), and hematoma (3.5%) being the most common events. Hernia recurrence occurred in 6.0% of patients during follow-up. Multivariable analysis identified obesity (p < 0.001), large defect size (W3) (p < 0.001), diabetes mellitus (p = 0.004), recurrent hernia (p = 0.013), and ASA III–IV status (p = 0.038) as independent predictors of postoperative complications. The predictive model demonstrated moderate discrimination (AUC ≈ 0.73). Conclusions: Retromuscular incisional hernia repair is associated with acceptable morbidity and low recurrence rates. Obesity (OR 2.41), large defect size (W3) (OR 2.12), diabetes mellitus (OR 1.89), recurrent hernia (OR 1.67), and American Society of Anesthesiologists (ASA) classification III–IV status (OR 1.54) were identified as independent predictors of postoperative complications. The predictive model demonstrated moderate discrimination (AUC ≈ 0.73), supporting its potential role in clinical risk stratification and perioperative decision-making.