BACKGROUND: Since 2011, the New England VA Hernia Registry (NEVAHR) prospectively collected operative details of ventral hernia repairs (VHRs) from 5 VA medical centers. This study aims to determine factors associated with recurrence. METHODS: Recurrence and surgical site occurrences (SSO) were directly identified via clinical and operative notes and/or imaging. Analysis was conducted via logistical regression. RESULTS: There were 681 VHRs. Mesh was used in 589 (86.5 %) repairs and was associated with larger average defect sizes (p <
0.001) and incisional hernias (p = 0.007). There were 117 (19.9 %) recurrences among mesh repairs and 22 (23.9 %) among suture repairs (p = 0.033). Among mesh repairs, recurrence was associated with higher BMI (p = 0.009), smoking (p = 0.012), parastomal and subcostal hernias (p = 0.003
p = 0.042), SSOs (p = 0.009), laparoscopy (p = 0.042), and smaller mesh-fascia overlap (p = 0.039). No factors associated with recurrence among suture repairs. CONCLUSION: Despite proper decision-making by NEVAHR surgeons, suture repair underperforms for hernias >
2 cm. Utility of suture repair for defects <
2 cm requires more investigation.