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

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.