OBJECTIVES: Little information is available on complication-related resource utilization and costs over time in patients with complex abdominal wall reconstruction.  Under pay-for-performance requirements financial decision-makers need better information to allocate healthcare resources and budget dollars.  This analysis reports complication-related resource utilization and costs over time in a real-world patient population undergoing complex abdominal wall reconstruction.  METHODS: A cohort of patients with complex abdominal wall reconstructions during inpatient stays between1/1/08 and 6/30/11 (Index event) were followed for 12 months.  Related complications, returns for facility-based care and related costs were evaluated for 30-60-90-365 days after discharge.  Insurance claims from the Truven Health Analytics MarketScan® database, inpatient costs from the Healthcare Cost and Utilization Project (HCUP) and costs reported for Ambulatory Patient Classifications (APC) were used to estimate costs from the hospital perspective.   RESULTS: ) and 17.0(sd 19.6), respectively; p< 0.0001.  CONCLUSIONS: Healthcare resource utilization, costs and complications for complex abdominal wall reconstruction patients increase over time.  Resource utilization is exacerbated when complications occur.  Further study may be required to validate these findings.