Beyond the radiology report: a multi-criteria decision analysis to define essential CT parameters for abdominal wall reconstruction : STAMP-C framework for preoperative hernia imaging.

Abstract

<h4>Background</h4>Comprehensive preoperative CT assessment is essential for ventral hernia repair, yet no standardized reporting framework exists. This study evaluated the completeness of preoperative abdominal CT reports and developed an evidence-based protocol to guide standardized reporting for abdominal wall reconstruction (AWR).<h4>Methods</h4>We conducted a systematic evaluation of CT reporting completeness in 834 patients who underwent elective transversus abdominis release (TAR) at the Cleveland Clinic Center for Abdominal Core Health between January 2020 and December 2024. A panel of AWR experts defined 16 CT-based parameters deemed essential for surgical planning, and their clinical relevance was validated through a global survey of 61 AWR surgeons. Radiologic reports were assessed for documentation of these parameters and compared with intraoperative findings and registry data from the Abdominal Core Health Quality Collaborative (ACHQC). Parameters were classified as either generalizable or patient specific. A Multi-Criteria Decision Analysis using the Analytic Hierarchy Process was applied to prioritize features for standardized reporting.<h4>Results</h4>Overall documentation completeness was limited, with a median of 34.4%. Although surgeons rated defect width as the most critical parameter for operative planning, it was documented in only 32.6% of CT reports. Patient-specific findings demonstrated higher overall reporting rates (median 87.8%), though key features such as mesh presence and anatomical mesh plane were documented in only 36.2% and 1.7% of applicable cases, respectively. Multi-Criteria Decision Analysis identified defect Size, Tanaka index, Anatomical hernia location, presence of prior Mesh, old mesh Plane and Concurrent inguinal or stomal site hernia as the most critical parameters for preoperative evaluation.<h4>Conclusion</h4>Substantial gaps exist between CT reporting and the informational needs of AWR surgeons. We propose the "STAMP-C" framework as a pragmatic, consensus-driven model to standardize ventral hernia CT assessment and improve multidisciplinary alignment in preoperative planning. Prospective validation of this framework across diverse institutional settings and hernia subtypes is needed before universal adoption can be recommended.