Successful ventral hernia repair (VHR) requires the right operation to be performed on the right patient for the right reason. Risk stratification tools and prediction can inform clinical decision-making to reduce complications and improve outcomes. At the point of care and prior to surgery, clinical prediction models can capture patient-, hernia-, and surgery-related risk factors, providing the surgeon with a meaningful assessment of patient risk. Tools in use today include the European Hernia Society (EHS), the Hernia Wound Risk Assessment Tool (HW-RAT), the Ventral Hernia Risk Score (VHRS), the HERNIAscore, the Ventral Hernia Working Group (VHWG), the Modified VHWG, and the Carolinas Equation for Determining Associated Risk (CeDAR). These tools have been validated for outcomes including recurrence, surgical-site occurrences (SSOs), and surgical-site infections (SSIs). Additional outcomes that should be considered in risk prediction for VHR include quality of life, recovery, and mortality. The ideal risk stratification tool balances precision with practicality for clinical use. Future efforts in this field should focus on advanced quantitative techniques to improve prediction power, efforts to generalize and validate prediction across diverse populations, and strategies to better implement prediction into everyday practice to improve outcomes.