Smoking cessation and weight loss before ventral hernia repair – can we really justify this? A single center cohort study

Smoking and adiposity are risk factors for poor postoperative outcomes after hernia surgery. This study evaluated a real-world hospital-based prehabilitation program covering smoking cessation and weight loss prior to ventral hernia repair. In this retrospective single-center cohort study, patients enrolled in a non-standardized smoking cessation or weight loss program prior to ventral hernia repair between June 2021 and December 2024 were included. Patients in the smoking cessation program were offered counseling and motivational interviews by nurse specialists. Patients in the weight loss program received the same in addition to a target weight and dietary guidance. Follow-up occurred every 2–8 weeks according to patient preference. Success was defined as cessation of smoking for ≥ 6 weeks or reaching target weight followed by ventral hernia repair. A total of 107 patients were identified: 12 (11.2%) participated in the smoking cessation program, 77 (72.0%) in the weight loss program, and 18 (16.8%) in both programs. Of these, 28 patients (26.2%) completed prehabilitation and underwent surgery, whereas 28 (26.2%) did not and remained in the program at the end of follow-up. A total of 27 (25.2%) patients dropped out, 14 (13.1%) were discontinued due to lack of progress, 8 (7.4%) were lost to follow-up, and 3 (2.8%) required emergency surgery. The median time from intervention to surgery was 325 days [IQR: 225.3, 496.5]. Only one in four patients completed prehabilitation and underwent surgery. The program was resource-intensive, with substantial dropouts and failure rates. These results highlight the challenges associated with preoperative lifestyle modification prior to hernia surgery.