Do female patients experience worse outcomes than male patients after inguinal hernia repair? An analysis of the Abdominal Core Health Quality Collaborative database.

Abstract

Inguinal hernia repair is one of the most common general surgery operations. Some evidence suggests that female patients are at greater risk of chronic postoperative pain and hernia recurrence. We investigated rates of chronic inguinal pain and recurrence after inguinal hernia repair in both male and female patients using the Abdominal Core Health Quality Collaborative database. The Abdominal Core Health Quality Collaborative database was queried for patients undergoing elective, unilateral inguinal hernia repair who completed 30-day clinical follow-up and baseline and 1-year European Registry for Abdominal Wall Hernias Survey surveys. Both open and minimally invasive cases were included. The primary outcomes of this study were 1-year European Registry for Abdominal Wall Hernias Survey pain, restrictions, and cosmesis scores. The secondary outcome was hernia recurrence. The search identified 1,582 total patients, 1,448 male and 134 female. One-year overall European Registry for Abdominal Wall Hernias Survey and European Registry for Abdominal Wall Hernias Survey pain scores were worse in female patients (P < .01 and P = .02, respectively). On multivariable regression analysis, female sex was associated with worse pain (adjusted effect size, 0.77; 95% confidence interval, 0.17-1.37, P = .01), restriction (adjusted effect size, 1.66; 95% confidence interval, 0.76-2.56, P < .01), and cosmesis scores (adjusted effect size, 0.74;95% confidence interval, 0.18-1.29, P < .01) compared with male sex. Hernia recurrence rates were greater in female patients at 1-year follow-up (adjusted odds ratio, 2.20; 95% confidence interval, 1.10-4.41, P = .03). This study demonstrates that quality of life and hernia recurrence are strikingly worse for female patients, despite a greater prevalence of minimally invasive repairs. Identification of these disparities in outcomes is the first step toward achieving health equity in inguinal hernia repair.