PURPOSE: Identify the body mass index (BMI) threshold at which the risk of recurrence increases after hernia repair. METHODS: In this retrospective observational study, clinical data were collected from patients who underwent ventral hernia repair within a county-wide health system from to 2014-2020. Classification and Regression Tree (CART) analysis was used to determine the BMI threshold at which recurrence rate significantly increased. Bivariate and multivariable Cox regression analyses were used to determine the association of the identified threshold and other factors with recurrence. The Kaplan-Meyer analysis described the long-term recurrence risk based on the identified BMI threshold. RESULTS: 478 patients with a median BMI of 32.5 kg/m (IQR = 29.9-36.3) were included. The recurrence rate was 14.4% over a median follow-up interval of 858.5 days (IQR = 138-1252). On CART analysis, BMI > 33.67 kg/m was associated with significantly increased recurrence rates (23.6% vs. 8.4%, p <.001). In the Cox regression analysis, cirrhosis (OR:4.205 [95% CI:1.608-10.995), p =.003], urgent or emergent repair (OR:2.111 [95% CI:1.029-4.332), p =.042], and BMI > 33.67 kg/m [OR:2.179 (95% CI:1.284-3.669), p =.004] were found to be independently associated with recurrence. In addition, patients with a BMI > 33.67 kg/m2 had a statistically significant decrease in the six-year recurrence-free rate (p <.001). CONCLUSIONS: BMI > 33.67 kg/m was the identified threshold at which hernia recurrence rate significantly increased in patients in a large county hospital system who underwent ventral hernia repair, and the risk continued for up to 6 years. A history of cirrhosis and urgent or emergent repair were also found to be independently associated with hernia recurrence.