Mesh infection following tension-free repair of abdominal external hernia is one of the most challenging and severe complications in the field of hernia surgery. Although its overall incidence is low, once it occurs—particularly in cases of delayed-onset mesh infection—the management process is extremely complex. It causes significant physical and psychological suffering imposes a substantial economic burden to patients, and places considerable pressure on the healthcare system. Unlike the acute infections that occur early after surgery, delayed-onset mesh infection has distinct clinical and pathological characteristics, with its core pathogenesis closely related to the formation of bacterial biofilms. This article systematically analyzes the risk factors associated with delayed-onset mesh infection following tension-free repair of abdominal external hernia, aiming to provide a reference for effective risk stratification, the development of preventive strategies, and the selection of appropriate treatment plans.