Women Undergoing Ventral Hernia Repair Face Higher Wound Morbidity and Late Recurrence: JAMA
Researchers have found in a new study that women undergoing ventral hernia repair (VHR) presented with greater hernia complexity and experienced higher early wound morbidity and increased late recurrence than men. Despite these challenges, women reported substantial patient-reported benefits. The findings highlight the need for sex-specific risk stratification, individualized preoperative counseling, and long-term follow-up, with further longitudinal studies needed to confirm these differences. The study was published in JAMA Surgery by Emily L. and colleagues.
To identify differences based on sex in terms of short-term post-operative complications, mid-term hernia recurrence, and patient-reported outcomes, the research group designed a prospective, multi-institutional cohort study utilizing the registry data available in the ACHQC. In total, 31,358 adult patients having undergone surgery for a primary or incisional ventral hernia repair from January 2012 to December 2023 were identified. Data analysis was performed during May-September 2026.
Of these patients, 14,303 (45.6%) were female and 17,055 (54.4%) were male. Primary end points included 30-day wound morbidity which entailed surgical site infection (SSI), surgical-site occurrences (SSO), SSO requiring procedural intervention (SSO-PI), 30-day hospital readmission, and length of stay. Secondary end points included annual pragmatic hernia recurrence rates within three years post-operatively, and validated patient-reported outcomes for quality of life and abdominal pain.
Key findings:
- The analysis performed on 31,358 patients (14,303 female versus 17,055 male) showed significant differences in demographics, anatomy, and clinical presentation between men and women.
- Women were younger (mean age 55.0 ± 14.6 versus 56.5 ± 13.0 years) and had higher body mass index (mean 32.1 ± 7.6 versus 31.7 ± 5.9 kg/m²).
- Women had more complicated hernia phenotypes characterized by higher numbers of incisional, recurrent, and larger hernias.
- Compared to men, women had higher 30-day readmission (483 [3.4%] versus 428 [2.5%]), higher SSI (370 [2.6%] versus 284 [1.7%]), higher SSO (1,323 [9.2%] versus 1,286 [7.5%]), and higher SSO-PI (517 [3.6%] versus 434 [2.5%]; all p < 0.001).
- Being a woman independently increased the risk of developing SSI (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.
- Although 1-year clinical outcomes and recurrence rates were similar between the sexes, women showed higher rates of hernia recurrence at 2 years (444 [19.3%] versus 406 [15.7%]) and 3 years (351 [20.9%] versus 320 [17.6%]).
- Despite higher morbidity, women had worse quality of life and pain but improved functionally more at 1 year postoperatively.
In summary, ACHQC registry findings prove that women with ventral hernia defects undergo a procedure where there is a higher incidence of defect complexity, more early wound complications, and higher rates of late recurrence compared to males. It is important to state that the study conclusions show that in spite of the higher risks associated, females still experience significant improvements in their quality of life.
Reference:
Breeding EL, Polcz M, Huang L, Blackman M, Bradley JF, Pierce R. Comparison of Outcomes Between Men and Women Undergoing Ventral Hernia Repair. JAMA Surg. Published online October 28, 2026. doi:10.1001/jamasurg.2026.5042
