Higher BMI negatively affects recovery in incisional hernia repair, making patient selection crucial.

• 42,081 patients analyzed showed no link between BMI and intraoperative or general complications.
• Elevated BMI is associated with higher postoperative complications, reoperations, and recurrence rates.

Consider recommending preoperative weight loss to reduce these risks for patients with high BMI.

• Chronic pain at rest and exertion increased in patients with higher BMI classes.