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Introduction: Abdominal wall hernias are a common problem facing surgeons today. As the patient population ages not only is there an increase in the number of co-morbidities but a decrease in the ability to perform basic daily activities. Within the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) this is tracked as a patient’s pre-operative functional health status. Methods: We reviewed all patients that underwent abdominal wall hernia repair from 2005-2010 in the ACS NSQIP database. Patients were identified based on the following CPT codes: 49560, 49561, 49565, 49566, 49568, 49570, 49572, 49585, 49586, 49652, 29653, 49654, 49655, 49656, and 49657. Patients were grouped based on functional status as listed in NSQIP - independent, partially dependent and totally dependent. Any patients with an unknown functional health status were excluded. Pre-operative and operative variables were recorded for all patients. Short-term outcomes between the groups were then compared.Results: 76397 patients were identified that underwent abdominal wall hernia repair. 74785 were classified as independent (97.9%), 1317 as partially dependent (1.7%) and 295 as totally dependent (0.4%). Classification as totally dependent was associated with a significant increase risk in all short term outcomes examined: wound occurrence, pneumonia, pulmonary embolism, urinary tract infection, myocardial infarction, deep venous thrombosis, sepsis, return to the operating room and death (p<0.001 for all). Discussion: Given the significant increase in complications and mortality following ventral hernia repair in patients with limited functional health status, a period of watchful waiting should be strongly advised, especially for asymptomatic hernias.
Short Term Outcomes Based on Functional Health Status

	Independent	%	Partially Dependent	%	Totally Dependent	%	p
Wound Occurrence	2968	4.0	133	10.1	44	14.9	<0.001
Pneumonia	479	0.6	69	5.2	44	14.9	<0.001
Pulmonary Embolism	150	0.2	14	1.1	4	1.4	<0.001
Urinary Tract Infection	648	0.9	46	3.5	25	8.5	<0.001
Myocardial Infarction	57	0.1	6	0.	5	1.7	<0.001
Deep Venous Thrombosis	195	0.3	19	1.4	10	3.4	<0.001
Sepsis	678	0.9	76	5.8	33	11.2	<0.001
Return to the OR within 30 days	1615	2.2	105	8.0	45	15.3	<0.001
Death	178	0.2	58	4.4	44	14.9	<0.001