{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:03:32Z","timestamp":1792785812002,"version":"4.5.0"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":39,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Edgar Schnohrs og Hustru\u2019s Fund"},{"name":"Prosektor Dr. med. Axel Emil S\u00f8eborg Ohlsen og \u00c6gtef\u00e6lde Else S\u00f8eborg Ohlsens Mindelegat","id":[{"id":"https:\/\/ror.org\/04663jx74","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100016380","name":"Bispebjerg Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100016380","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Evidence of the effects of obesity and smoking on complication-related reintervention after elective umbilical hernia mesh repair is limited. This study evaluated the association between these factors and reoperation after mesh repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A nationwide cohort of elective open umbilical hernia repairs from 2017 to 2020 was identified from prospective registration in the Danish Hernia Database. Patients were followed until 31 December 2023 through nationwide registries and complete scrutiny of operative notes associated with succeeding reinterventions. Study outcomes were reoperation for any complication, recurrence, or non-recurrence complication with special reference to the repair method. Multivariable analyses included cause-specific hazard models with adjustment for body mass index (BMI), smoking status, sex, age, and hernia size.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 2391 patients included in the study, 18.4% were smokers and 34.0% were obese (BMI &amp;gt; 30\u2005kg\/m2). The follow-up rate was 99.9% over a median of 4.65\u2005years. Reoperation for any complication was increased in smokers compared with non-smokers (hazard ratio (HR) 1.68; 95% confidence interval (c.i.) 1.05 to 2.69; P = 0.032). Reoperation for non-recurrence complications was more frequent in smokers (HR 2.01; 95% c.i. 1.19 to 3.38; P = 0.009) and obese patients (HR 1.83; 95% c.i. 1.12 to 3.00; P = 0.016). Comparable risks of reoperation for hernia recurrence were found between smokers and non-smokers (HR 0.80; 95% c.i. 0.23 to 2.73; P = 0.721) and between patients with and without obesity (HR 0.73; 95% c.i. 0.26 to 2.09; P = 0.559).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reoperation for any complication after open umbilical hernia mesh repair was more frequent in smokers, whereas no independent association was observed between patients with and without obesity. Smoking and obesity were associated with an increased risk of reoperation for non-recurrence complications, while not affecting reoperation for hernia recurrence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag136","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:18:29Z","timestamp":1784546309000},"source":"Crossref","is-referenced-by-count":0,"title":["Smoking, obesity and reoperation after elective open mesh repair of umbilical hernia: nationwide cohort study"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9709-9647","authenticated-orcid":false,"given":"Jeppe","family":"Fredberg","sequence":"first","affiliation":[{"name":"Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0273-8992","authenticated-orcid":false,"given":"Erling","family":"Oma","sequence":"additional","affiliation":[{"name":"Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5702-8352","authenticated-orcid":false,"given":"Frederik","family":"Helgstrand","sequence":"additional","affiliation":[{"name":"Department of Surgery, Zealand University Hospital , Koege ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7465-5374","authenticated-orcid":false,"given":"Lars N","family":"Jorgensen","sequence":"additional","affiliation":[{"name":"Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen , Copenhagen ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"2026101312095527300_zrag136-B1","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s10029-011-0863-4","article-title":"Prevalence of adult paraumbilical hernia. Assessment by high-resolution sonography: a hospital-based study","volume":"16","author":"Bedewi","year":"2012","journal-title":"Hernia"},{"key":"2026101312095527300_zrag136-B2","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s10029-009-0592-0","article-title":"Establishment and initial experiences from the Danish ventral hernia database","volume":"14","author":"Helgstrand","year":"2010","journal-title":"Hernia"},{"key":"2026101312095527300_zrag136-B3","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/S0039-6109(05)70363-7","article-title":"Epidemiologic economic and sociologic aspects of hernia surgery in the United States in the 1990s","volume":"78","author":"Rutkow","year":"1998","journal-title":"Surg Clin North Am"},{"key":"2026101312095527300_zrag136-B4","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1007\/s10029-015-1376-3","article-title":"The prevalence of umbilical and epigastric hernia repair: a nationwide epidemiologic study","volume":"19","author":"Burcharth","year":"2015","journal-title":"Hernia"},{"key":"2026101312095527300_zrag136-B5","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1002\/bjs5.50276","article-title":"Mesh versus suture in elective repair of umbilical hernia: systematic review and meta-analysis","volume":"4","author":"Madsen","year":"2020","journal-title":"BJS Open"},{"key":"2026101312095527300_zrag136-B6","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/j.amjsurg.2014.05.021","article-title":"Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study","volume":"209","author":"Christoffersen","year":"2015","journal-title":"Am J Surg"},{"key":"2026101312095527300_zrag136-B7","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/S0140-6736(18)30298-8","article-title":"Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial","volume":"391","author":"Kaufmann","year":"2018","journal-title":"Lancet"},{"key":"2026101312095527300_zrag136-B8","doi-asserted-by":"crossref","first-page":"4253","DOI":"10.1007\/s00464-025-11792-4","article-title":"Emergency umbilical and epigastric hernia repair: nationwide registry-based study of long-term recurrence, mesh-related, and other complications","volume":"39","author":"Fredberg","year":"2025","journal-title":"Surg Endosc"},{"key":"2026101312095527300_zrag136-B9","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s10029-016-1466-x","article-title":"Surgical outcome of mesh and suture repair in primary umbilical hernia: postoperative complications and recurrence","volume":"20","author":"Winsnes","year":"2016","journal-title":"Hernia"},{"key":"2026101312095527300_zrag136-B10","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.jss.2016.08.009","article-title":"The cost of preventable comorbidities on wound complications in open ventral hernia repair","volume":"206","author":"Cox","year":"2016","journal-title":"J Surg Res"},{"key":"2026101312095527300_zrag136-B11","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/s10029-025-03325-8","article-title":"Implementation of a prehabilitation program before abdominal wall surgery: a pilot and feasibility study","volume":"29","author":"Joliat","year":"2025","journal-title":"Hernia"},{"key":"2026101312095527300_zrag136-B12","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.jss.2024.11.024","article-title":"The impact of surgical prehabilitation on postoperative patient outcomes: a systematic review","volume":"306","author":"Kann","year":"2025","journal-title":"J Surg Res"},{"key":"2026101312095527300_zrag136-B13","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1097\/SLA.0b013e3181889d0d","article-title":"Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial","volume":"248","author":"Lindstr\u00f6m","year":"2008","journal-title":"Ann Surg"},{"key":"2026101312095527300_zrag136-B14","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.surg.2020.04.012","article-title":"Smoking and obesity are associated with increased readmission after elective repair of small primary ventral hernias: a nationwide database study","volume":"168","author":"Henriksen","year":"2020","journal-title":"Surgery"},{"key":"2026101312095527300_zrag136-B15","doi-asserted-by":"crossref","first-page":"zraa071","DOI":"10.1093\/bjsopen\/zraa071","article-title":"Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis","volume":"5","author":"Parker","year":"2021","journal-title":"BJS Open"},{"key":"2026101312095527300_zrag136-B16","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/s10029-022-02573-2","article-title":"The European Hernia Society prehabilitation project: a systematic review of patient prehabilitation prior to ventral hernia surgery","volume":"26","author":"Jensen","year":"2022","journal-title":"Hernia"},{"key":"2026101312095527300_zrag136-B17","doi-asserted-by":"crossref","first-page":"e1001885","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies conducted using observational routinely-collected health data (RECORD) statement","volume":"12","author":"Benchimol","year":"2015","journal-title":"PLoS Med"},{"key":"2026101312095527300_zrag136-B18","doi-asserted-by":"crossref","first-page":"719","DOI":"10.2147\/CLEP.S99501","article-title":"The Danish ventral hernia database\u2014a valuable tool for quality assessment and research","volume":"8","author":"Helgstrand","year":"2016","journal-title":"Clin Epidemiol"},{"key":"2026101312095527300_zrag136-B19","first-page":"A4708","article-title":"High agreement between the Danish ventral hernia database and hospital files","volume":"60","author":"Helgstrand","year":"2013","journal-title":"Dan Med J"},{"key":"2026101312095527300_zrag136-B20"},{"key":"2026101312095527300_zrag136-B21","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1007\/s10029-017-1724-6","article-title":"Comparison of hernia registries: the CORE project","volume":"22","author":"Kyle-Leinhase","year":"2018","journal-title":"Hernia"},{"key":"2026101312095527300_zrag136-B22","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"key":"2026101312095527300_zrag136-B23","doi-asserted-by":"crossref","first-page":"449","DOI":"10.2147\/CLEP.S91125","article-title":"The Danish National Patient Registry: a review of content, data quality, and research potential","volume":"7","author":"Schmidt","year":"2015","journal-title":"Clin Epidemiol"},{"key":"2026101312095527300_zrag136-B24","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1177\/1403494810387965","article-title":"The Danish Civil Registration System","volume":"39","author":"Pedersen","year":"2011","journal-title":"Scand J Public Health"},{"key":"2026101312095527300_zrag136-B25","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s10654-014-9930-3","article-title":"The Danish Civil Registration System as a tool in epidemiology","volume":"29","author":"Schmidt","year":"2014","journal-title":"Eur J Epidemiol"},{"key":"2026101312095527300_zrag136-B26","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1214\/aos\/1176350951","article-title":"A class of K-sample tests for comparing the cumulative incidence of a competing risk","volume":"16","author":"Gray","year":"1988","journal-title":"Ann Stat"},{"key":"2026101312095527300_zrag136-B27","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1001\/jama.2016.15217","article-title":"Long-term recurrence and complications associated with elective incisional hernia repair","volume":"316","author":"Kokotovic","year":"2016","journal-title":"JAMA"},{"key":"2026101312095527300_zrag136-B28","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.1007\/s10029-024-03122-9","article-title":"The impact of smoking on ventral and inguinal hernia repair: a systematic review and meta-analysis","volume":"28","author":"Da Silveira","year":"2024","journal-title":"Hernia"},{"key":"2026101312095527300_zrag136-B29","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/S0140-6736(02)07369-5","article-title":"Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial","volume":"359","author":"M\u00f8ller","year":"2002","journal-title":"Lancet"},{"key":"2026101312095527300_zrag136-B30","doi-asserted-by":"crossref","first-page":"s7","DOI":"10.1089\/sur.2006.7.s1-7","article-title":"Risk factors for surgical site infection","volume":"7","author":"Cheadle","year":"2006","journal-title":"Surg Infect"},{"key":"2026101312095527300_zrag136-B31","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1097\/SLA.0b013e31824f632d","article-title":"Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy a systematic review","volume":"255","author":"S\u00f8rensen","year":"2012","journal-title":"Ann Surg"},{"key":"2026101312095527300_zrag136-B32","doi-asserted-by":"crossref","first-page":"7720","DOI":"10.1007\/s00464-025-12206-1","article-title":"Do smokers deserve \u201cNo\u201d? Management and outcomes of smokers undergoing elective ventral hernia repair","volume":"39","author":"Howard","year":"2025","journal-title":"Surg Endosc"},{"key":"2026101312095527300_zrag136-B33","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1016\/j.amjsurg.2015.08.001","article-title":"Tailoring surgical approach for elective ventral hernia repair based on obesity and national surgical quality improvement program outcomes","volume":"210","author":"Regner","year":"2015","journal-title":"Am J Surg"},{"key":"2026101312095527300_zrag136-B34","doi-asserted-by":"crossref","first-page":"3584","DOI":"10.1007\/s00464-019-07129-7","article-title":"Updated outcomes of laparoscopic versus open umbilical hernia repair in patients with obesity based on a national surgical quality improvement program review","volume":"34","author":"Williams","year":"2020","journal-title":"Surg Endosc"},{"key":"2026101312095527300_zrag136-B35","doi-asserted-by":"crossref","first-page":"7200","DOI":"10.1007\/s00464-020-08217-9","article-title":"Ten-year trends in minimally invasive hernia repair: a NSQIP database review","volume":"35","author":"Madion","year":"2021","journal-title":"Surg Endosc"},{"key":"2026101312095527300_zrag136-B36","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s10029-018-1843-8","article-title":"Umbilical hernia repair with composite prosthesis: a single-centre experience","volume":"23","author":"Porrero","year":"2019","journal-title":"Hernia"},{"key":"2026101312095527300_zrag136-B37","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1001\/jamasurg.2024.0233","article-title":"Year-over-year ventral hernia recurrence rates and risk factors","volume":"159","author":"Bhardwaj","year":"2024","journal-title":"JAMA Surg"},{"key":"2026101312095527300_zrag136-B38","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1001\/jamasurg.2024.1696","article-title":"Surgical approach and long-term recurrence after ventral hernia repair","volume":"159","author":"Fry","year":"2024","journal-title":"JAMA Surg"},{"key":"2026101312095527300_zrag136-B39"},{"key":"2026101312095527300_zrag136-B40","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1159\/000516047","article-title":"Excess body weight and abdominal hernia","volume":"37","author":"Dietz","year":"2021","journal-title":"Visc Med"},{"key":"2026101312095527300_zrag136-B41","doi-asserted-by":"crossref","first-page":"6","DOI":"10.17756\/jocd.2016-003","article-title":"The effect of obesity on outcomes of ventral hernia repair: a propensity score matching analysis","volume":"1","author":"Borad","year":"2017","journal-title":"J Obes Chronic Dis"},{"key":"2026101312095527300_zrag136-B42","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/SLE.0000000000001160","article-title":"Preoperative optimization before ventral hernia repair: a systematic review and meta-analysis","volume":"33","author":"Marcolin","year":"2023","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"2026101312095527300_zrag136-B43","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.amjsurg.2021.12.024","article-title":"Systematic review and meta-analysis of risk factors for mesh infection following abdominal wall hernia repair surgery","volume":"224","author":"Quiroga-Centeno","year":"2022","journal-title":"Am J Surg"},{"key":"2026101312095527300_zrag136-B44","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1001\/jamasurg.2025.3915","article-title":"Long-term risk of mesh infection requiring removal after elective ventral hernia repair","volume":"160","author":"Ehlers","year":"2025","journal-title":"JAMA Surg"},{"key":"2026101312095527300_zrag136-B45","first-page":"15","article-title":"Is pooled data analysis of ventral and incisional hernia repair acceptable?","volume":"2","author":"K\u00f6ckerling","year":"2015","journal-title":"Front Surg"},{"key":"2026101312095527300_zrag136-B46","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1097\/SLA.0b013e318254f5b9","article-title":"Reoperation versus clinical recurrence rate after ventral hernia repair","volume":"256","author":"Helgstrand","year":"2012","journal-title":"Ann Surg"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/5\/zrag136\/71914047\/zrag136.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/5\/zrag136\/71914047\/zrag136.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:10:08Z","timestamp":1791907808000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zrag136\/8914506"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":46,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9,4]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zrag136","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,9,4]]},"article-number":"zrag136"}}