Comparison of Outcomes Between Men and Women Undergoing Ventral Hernia Repair

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.