STRONG prehabilitation before elective ventral hernia repair: Learnings from recruitment challenges in a randomized controlled trial.
Sofie Anne-Marie Skovbo Jensen, Susanne Vahr Lauridsen, Siv Fonnes et al.
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In 30 seconds
The multicentre, parallel-group STRONG-Hernia randomised controlled trial assessed intensive lifestyle prehabilitation before elective ventral hernia repair in adults with at least one risky smoking, nutrition, alcohol, or physical-inactivity factor. Recruitment was slow, and the trial stopped early after randomising 43 participants, far below the planned 2 × 199. By the end of the intervention, 13/19 prehabilitation participants had optimised all risky lifestyle factors, compared with 0/22 receiving standard care (p < 0.01). Postoperative complications occurred in 3/16 and 4/19 participants, respectively (p = 1.00); the study was not powered to assess this outcome.
Key findings
- All risky lifestyle factors were optimised in 13/19 prehabilitation participants versus 0/22 controls (p < 0.01).
- At 30 days, complications occurred in 3/16 prehabilitation participants and 4/19 controls (p = 1.00).
- The trial randomised 43 participants against a planned enrolment of 2 × 199 and was terminated early for slow recruitment.
Why it matters
The trial suggests that structured, tailored support may help patients address modifiable lifestyle risks before ventral hernia repair. However, its small, prematurely terminated sample cannot establish whether this translates into fewer postoperative complications. The recruitment difficulties also highlight the practical challenge of evaluating prehabilitation in this surgical population and the need for a feasible strategy before a definitive trial.
What to keep in mind
Early termination for slow recruitment left the trial substantially below its planned sample size and underpowered to assess postoperative complications. Lifestyle findings are preliminary.