Adjusting for patient demographics and medical history revealed an association between increasing risk of PE and fascial defect >10 cm, with the laparoscopic approach associated with greater risk of both DVT and PE when the fascial defect size is >10 cm.
Key Findings
Results
Larger hernia defect size was associated with significantly higher rates of VTE and PE after ventral hernia repair.
A total of 12,947 VHRs were recorded: 46% <3 cm, 42% 3-10 cm, and 12% >10 cm.
VTE occurred in 6 (0.1%), 10 (0.2%), and 13 (0.8%) patients for <3 cm, 3-10 cm, and >10 cm defects respectively (p < 0.001).
PE occurred in 5 (0.1%), 10 (0.2%), and 12 (0.8%) patients for <3 cm, 3-10 cm, and >10 cm defects respectively (p < 0.001).
Data were drawn from the 2023 National Surgical Quality Improvement Program (NSQIP) dataset.
Results
After adjusting for patient demographics and medical history, defects >10 cm were associated with significantly increased risk of PE compared to defects <3 cm.
Adjusted relative risk of PE for >10 cm vs. <3 cm was 3.59 (95% CI: 1.18, 10.91).
Adjusted relative risk of PE for 3-10 cm vs. <3 cm was 1.62 (95% CI: 0.55, 4.83), which was not statistically significant.
Relative risk of VTE for >10 cm vs. <3 cm was 2.45 (95% CI: 0.88, 6.77), which did not reach statistical significance after adjustment.
Relative risks were modeled by logistic regression to account for differences in patient characteristics between groups.
Results
The laparoscopic operative approach for defects >10 cm was associated with significantly increased risk of both VTE and PE.
Adjusted relative risk of VTE for laparoscopic repair of defects >10 cm was 6.63 (95% CI: 1.32, 33.4).
Adjusted relative risk of PE for laparoscopic repair of defects >10 cm was 9.69 (95% CI: 1.79, 52.4).
Stratification by operative approach demonstrated these significantly increased risks specifically in the fascial defect size >10 cm group when repaired laparoscopically.
Results
Recurrent hernias were associated with a higher incidence of PE compared to hernias at initial presentation.
PE incidence was 0.5% (7 cases) for recurrent hernias vs. 0.2% (20 cases) for initial presentation (p = 0.01).
This finding emerged on further analysis stratifying by hernia type.
The total number of PE events across the entire cohort was 27 (0.2%).
Conclusions
The authors recommend considering chemical thromboprophylaxis for patients undergoing ventral hernia repair with fascial defects >10 cm.
This recommendation is based on both the adjusted association between defect >10 cm and PE risk (RR 3.59, 95% CI: 1.18, 10.91) and the markedly elevated risk seen with the laparoscopic approach (RR for PE: 9.69, 95% CI: 1.79, 52.4).
VTE and PE are described as 'potentially preventable postoperative complications with significant morbidity.'
New CPT codes for ventral hernia repair stratified by fascial defect size were introduced in 2023, providing the clinical coding framework for this analysis.
What This Means
This research suggests that the size of a hernia defect — the gap in the abdominal wall that needs to be repaired — matters when it comes to the risk of serious blood clot complications after surgery. Using a large national surgical database of nearly 13,000 hernia repairs performed in 2023, researchers found that patients with the largest hernia defects (greater than 10 cm, roughly 4 inches) had significantly higher rates of dangerous blood clots in the lungs (pulmonary embolism) compared to patients with the smallest defects (under 3 cm). Even after accounting for differences in patients' age, health history, and other factors, those with large defects had approximately 3.6 times the risk of pulmonary embolism.
A particularly striking finding involved the surgical approach: when large defects (>10 cm) were repaired using a laparoscopic (minimally invasive) technique, the risk of both deep vein thrombosis and pulmonary embolism was dramatically higher — nearly 7 times and nearly 10 times higher, respectively — compared to smaller defects repaired the same way. Additionally, patients undergoing repair of a hernia that had already come back once (recurrent hernia) had a higher rate of pulmonary embolism than those having their first repair.
This research suggests that surgeons and care teams should pay close attention to hernia defect size and surgical approach when planning blood clot prevention strategies. Specifically, the authors suggest that blood-thinning medications (chemical thromboprophylaxis) should be considered for patients with large hernias (>10 cm), particularly when a laparoscopic approach is used. The introduction of new billing codes in 2023 that categorize hernia repairs by defect size may help make this type of risk-stratified care more systematic.
Subillaga O, Pérez Coulter A, Wu J. (2026). Does defect size matter? Risk of venous thromboembolism and pulmonary embolism after ventral hernia repair.. Hernia : the journal of hernias and abdominal wall surgery. https://doi.org/10.1007/s10029-026-03819-z