Women have more complications but better reported quality of life after elective ventral hernia repair

Abstract Background Although nearly half of elective ventral hernias are repaired in women, the literature on sex-specific disparities in postoperative complications and quality of life is limited. Understanding these differences is critical to setting patient expectations, informing risk counseling, and providing goal-concordant care. We opted to explore the influence of patient sex on postoperative outcomes and patient-reported quality of life using a national registry. Methods A retrospective cohort study was conducted using data from the Abdominal Core Health Quality Collaborative (ACHQC) Registry. Adult (≥ 18 years) patients who underwent elective ventral hernia repair from 1/2012 to 12/2023 were included if sex, operative data, and 30-day follow-up were complete. The primary outcome was postoperative complications. Secondary outcomes included patient-reported quality of life measured by the Hernia-Related Quality-of-Life Survey (HerQLes) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain scores. The Kruskal-Wallis test was used for continuous variables, and the Pearson test was used for categorical variables. Results Among 32,956 patients who underwent ventral hernia repair, 15,395 (46.7%) were female. Females had higher rates of readmission (3.2% vs. 2.5%, p < 0.001), wound-related readmission (1.1% vs. 0.6%, p < 0.001), SSIs (2.4% vs. 1.6%, p < 0.001), SSIs requiring debridement (0.5% vs. 0.2%, p = 0.02), pain requiring intervention (0.4% vs. 0.1%, p < 0.001), 2- and 3-year pragmatic hernia recurrence (19.2% vs. 15.5%, p < 0.001 and 21% vs. 17.6%, p = 0.01), and OR duration > 2 h (45% vs. 33%, p < 0.001). Despite this, females demonstrated more robust changes in HerQLes scores from baseline to 30 days (median 10 vs. 6.70, p < 0.001) and more notable changes in PROMIS pain T-scores from baseline to 1 year (median -2 vs. -1, p < 0.001). After multivariable analysis, female sex was associated with lower HerQLes scores at 1 year ( ß = -1.83, p = 0.037) and higher PROMIS pain scores at 30 days and 1 year ( ß = 0.35 and 0.47, respectively; both p < 0.001). Conclusion Female sex is associated with higher rates of postoperative complications but greater unadjusted improvement in patient-reported outcomes with worse adjusted postoperative quality of life and pain. These findings emphasize a discordance between clinical and patient-centered outcomes, suggesting that both should be considered when counseling patients and defining surgical success.