In a retrospective analysis of 4,195 clean open ventral hernia repairs from a prospectively maintained registry, figure-of-eight fascial closure was linked to higher 30-day surgical site infection than running closure (adjusted OR 1.47, 95% CI 1.11-1.95), with no reduction in recurrence. The study also found higher odds of SSO requiring procedural intervention with figure-of-eight closure (OR 1.31, 95% CI 1.02-1.70), reinforcing that your frontline wound surveillance and escalation decisions can directly shape safer postoperative care.

Why It Matters To Your Practice

• For NPs and PAs managing post-op checks, this is the kind of early pattern recognition that matters: the closure choice did not improve 1-year recurrence, but figure-of-eight closure was associated with more 30-day SSI.

• The study included large ventral hernia defects 10 cm or greater in CDC Class 1 wounds, making the findings especially relevant when you are tracking higher-risk abdominal surgery follow-up.

• Diabetes mellitus (DM), smoking, BMI, immunosuppression, age, sex, race, ASA class, and hernia size were controlled in multivariable analysis, so this was not a casual apples-to-oranges comparison.

Clinical Benefits

• Running closure may offer a cleaner short-term wound profile without sacrificing 1-year recurrence outcomes.

• That gives you stronger footing when reviewing op notes, anticipating wound issues, and counseling patients about what to watch for in the first 30 days.

• Your assessment is not secondary here: NPs and PAs are often the first clinicians to detect drainage, erythema, dehiscence, pain changes, or early infection that can determine whether a patient stays on track or needs intervention.

Managing Risks

• Do not overread the data: this was a retrospective study, and the authors note figure-of-eight closure may have been used selectively in more complex or high-tension repairs.

• Still, if a patient had figure-of-eight closure, that may justify a lower threshold for closer wound follow-up, patient education, and surgeon notification when concerning changes appear.

• No difference was seen in 30-day SSO overall or 1-year recurrence, and patient-reported quality of life was not meaningfully different.

The Bottom Line

• For clean open ventral hernia repair with large defects, running fascial closure outperformed figure-of-eight closure on SSI, while recurrence remained similar.

• Figure-of-eight closure may still have a role in difficult, high-tension reapproximation, but this study suggests it should be reserved rather than routine.

• Bottom line for frontline clinicians: your wound checks, triage instincts, and post-op escalation are exactly where evidence like this becomes better patient care.