Comparison of Outcomes Between Men and Women Undergoing Ventral Hernia Repair.
- 1Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
- 2Department of General Surgery, USF Health, Tampa, Florida.
- 3Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
Abstract
Importance
Sex-based differences in ventral hernia repair (VHR) outcomes remain incompletely characterized.Objective
To compare short-term clinical outcomes, recurrence through 3 years, and patient-reported outcomes between female and male patients undergoing VHR.Design, setting, and participants
This cohort study included patients undergoing VHR from January 2012 through December 2023, with follow-up through 3 years. Data were from the Abdominal Core Health Quality Collaborative (ACHQC), a prospective, multi-institutional clinical registry. Participants were adults undergoing primary or incisional VHR whose data were recorded in the ACHQC database. Data analysis was performed from May to September 2026.Exposures
Sex (female vs male).Main outcomes and measures
Primary outcomes included 30-day wound morbidity, comprising surgical site infection (SSI), surgical-site occurrence (SSO), and SSO requiring procedural intervention (SSO-PI), readmission, and length of stay. Secondary outcomes included pragmatic recurrence at 30 days, 1 year, 2 years, and 3 years and patient-reported quality of life and pain. Multivariable logistic regression assessed associations between sex and outcomes.Results
Among 31 358 patients, 14 303 (45.6%) were female and 17 055 (54.4%) were male. Women were younger than men (mean [SD] age, 55.0 [14.6] vs 56.5 [13.0] years, respectively) and had higher body mass index (mean [SD], 32.1 [7.6] vs 31.7 [5.9], respectively). Women presented with more complex hernia phenotypes, including higher rates of incisional, recurrent, and larger hernias. Compared with men, women experienced higher 30-day readmission (483 [3.4%] for women vs 428 [2.5%] for men), SSI (370 [2.6%] vs 284 [1.7%], respectively) SSO (1323 [9.2%] and 1286 [7.5%], respectively), and SSO-PI (517 [3.6%] vs 434 [2.5%], respectively; all P < .001), with no differences in reoperation or mortality. Female sex was independently associated with higher odds of SSI (odds ratio [OR], 1.40; 95% CI, 1.17-1.67) and SSO-PI (OR, 1.21; 95% CI, 1.04-1.40) after incisional hernia repair. Clinical outcomes and recurrence were similar at 1 year; however, women had higher recurrence at 2 years (444 [19.3%] vs 406 [15.7%] men) and 3 years (351 [20.9%] vs 320 [17.6%] men). Women reported worse baseline quality of life and pain but greater improvement after 1 year.Conclusions and relevance
This study found that women undergoing VHR presented with greater hernia complexity and experienced higher early wound morbidity and increased late recurrence, while achieving substantial patient-reported benefit. These findings may inform sex-specific risk stratification and counseling, although further studies with more longitudinal follow-up are needed.
Related
- Long-Term Patient-Reported Quality-of-Life Outcomes After Ventral Primary or Incisional Hernia Repair
- STRONG prehabilitation before elective ventral hernia repair: Learnings from recruitment challenges in a randomized controlled trial
- Radiologic recurrence after minimally invasive ventral hernia repair in patients with class III obesity: a single-center retrospective cohort study
- Prophylactic closed-incision negative pressure wound therapy for open ventral incisional hernia repair with mesh: a meta-analysis of randomized controlled trials.
- Long-Term Outcomes of Laparoscopic Total Extraperitoneal Repair for Recurrent Inguinal Hernia
BibTeX
@article{breeding2026comparison,
title = {{Comparison of Outcomes Between Men and Women Undergoing Ventral Hernia Repair.}},
author = {Emily L Breeding and Monica Polcz and Li-Ching Huang and Marisa Blackman and Joel F Bradley and Richard Pierce},
journal = {JAMA surgery},
year = {2026},
month = oct,
doi = {10.1001/jamasurg.2026.5042},
url = {https://europepmc.org/article/MED/42949738},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Comparison of Outcomes Between Men and Women Undergoing Ventral Hernia Repair.
AU - Emily L Breeding
AU - Monica Polcz
AU - Li-Ching Huang
AU - Marisa Blackman
AU - Joel F Bradley
AU - Richard Pierce
PY - 2026
DA - 2026/10/28
JO - JAMA surgery
DO - 10.1001/jamasurg.2026.5042
UR - https://europepmc.org/article/MED/42949738
AB - Importance Sex-based differences in ventral hernia repair (VHR) outcomes remain incompletely characterized.Objective To compare short-term clinical outcomes, recurrence through 3 years, and patient-reported outcomes between female and male patients undergoing VHR.Design, setting, and participants This cohort study included patients undergoing VHR from January 2012 through December 2023, with follow-up through 3 years. Data were from the Abdominal Core Health Quality Collaborative (ACHQC), a prospective, multi-institutional clinical registry. Participants were adults undergoing primary or incisional VHR whose data were recorded in the ACHQC database. Data analysis was performed from May to September 2026.Exposures Sex (female vs male).Main outcomes and measures Primary outcomes included 30-day wound morbidity, comprising surgical site infection (SSI), surgical-site occurrence (SSO), and SSO requiring procedural intervention (SSO-PI), readmission, and length of stay. Secondary outcomes included pragmatic recurrence at 30 days, 1 year, 2 years, and 3 years and patient-reported quality of life and pain. Multivariable logistic regression assessed associations between sex and outcomes.Results Among 31 358 patients, 14 303 (45.6%) were female and 17 055 (54.4%) were male. Women were younger than men (mean [SD] age, 55.0 [14.6] vs 56.5 [13.0] years, respectively) and had higher body mass index (mean [SD], 32.1 [7.6] vs 31.7 [5.9], respectively). Women presented with more complex hernia phenotypes, including higher rates of incisional, recurrent, and larger hernias. Compared with men, women experienced higher 30-day readmission (483 [3.4%] for women vs 428 [2.5%] for men), SSI (370 [2.6%] vs 284 [1.7%], respectively) SSO (1323 [9.2%] and 1286 [7.5%], respectively), and SSO-PI (517 [3.6%] vs 434 [2.5%], respectively; all P < .001), with no differences in reoperation or mortality. Female sex was independently associated with higher odds of SSI (odds ratio [OR], 1.40; 95% CI, 1.17-1.67) and SSO-PI (OR, 1.21; 95% CI, 1.04-1.40) after incisional hernia repair. Clinical outcomes and recurrence were similar at 1 year; however, women had higher recurrence at 2 years (444 [19.3%] vs 406 [15.7%] men) and 3 years (351 [20.9%] vs 320 [17.6%] men). Women reported worse baseline quality of life and pain but greater improvement after 1 year.Conclusions and relevance This study found that women undergoing VHR presented with greater hernia complexity and experienced higher early wound morbidity and increased late recurrence, while achieving substantial patient-reported benefit. These findings may inform sex-specific risk stratification and counseling, although further studies with more longitudinal follow-up are needed.
SN - 2168-6254
SN - 2168-6262
ER -