From preoperative to postoperative: gender differences in elective ventral hernia repair

Gender represents an important social construct, yet its impact on hernia care is poorly understood. This study aims to evaluate gender-based differences across the continuum of elective ventral hernia management. A retrospective cohort study was conducted for adults undergoing elective ventral hernia repair with mesh in the Abdominal Core Health Quality Collaborative registry. Patients were categorized as men or women. Variables analyzed included demographics, comorbidities, hernia characteristics, operative decision-making, postoperative outcomes, and patient-reported outcomes (PROs). Multivariable regression modeling evaluated associations between gender and postoperative outcomes. 27,046 patients were evaluated (53% men, 47% women). Women less often had private insurance (48% vs 56%, p < 0.001) and presented more frequently with larger (width 5 cm vs 4 cm; length 8 cm vs 4 cm, p < 0.001) and recurrent hernias (31% vs 24%, p < 0.001). Operative approach did not differ, yet women more often underwent lengthier repairs (> 2 h 53% vs 40%, p < 0.001) and myofascial release (44% vs 34%, p < 0.001). Women had worse adjusted length of stay (effect 0.219 days, p < 0.001), surgical site infection within 30 days (OR 1.310, p < 0.001), and surgical site infection/occurrence interventions within 30 days (OR 1.144, p = 0.047). They also reported lower quality of life and pain interference at baseline with greater gains across two years (p < 0.001). Women presented with more advanced hernia disease requiring more complex reconstruction with worse early morbidity. Despite this, women achieved greater gains in PRO scores relative to men. These findings highlight the need for earlier recognition and targeted optimization to ensure equitable management patterns of ventral hernias.