Female sex as independent risk factor for chronic pain following elective incisional hernia repair: registry-based, propensity score-matched comparison

Abstract

Introduction: To date, little attention has been paid by surgical scientific studies to sex as a potential influence factor on the outcome. Therefore, there is a sex bias in the surgical literature. With an incidence of more than 20% after 3 years, incisional hernias are a common complication following abdominal surgical procedures. The proportion of women affected is around 50%. There are very few references in the literature to the influence of sex on the outcome of elective incisional hernia repair.

Materials and methods: In all, 22,895 patients with elective incisional hernia repair from the Herniamed Registry were included in the study. The patients had undergone elective incisional hernia repair in a laparoscopic IPOM, open sublay, open IPOM, open onlay or suture technique. 1-year follow-up was available for all patients. Propensity score matching was performed for the 11,480 female (50.1%) and 11,415 male (49.9%) patients, creating 8138 pairs (82.0%) within fixed surgical procedures.

Results: For pain on exertion (11.7% vs 18.3%; p < 0.001), pain at rest (7.53% vs 11.1%; p < 0.001), and pain requiring treatment (5.4% vs 9.1%; p < 0.001) highly significant disadvantages were identified for the female sex when comparing the different results within the matched pairs. That was also confirmed on comparing sex within the individual surgical procedures. No sex-specific differences were identified for the postoperative complications, complication-related reoperations or recurrences. Less favorable intraoperative complication results in the female sex were observed only for the onlay technique.

Conclusions: Female sex is an independent risk factor for chronic pain after elective incisional hernia repair.

Keywords: Chronic pain; Female sex; Hernia registry; Incisional hernia; Postoperative complications; Recurrence.

Fig. 1

Flowchart of patient inclusion

Fig. 2

Standard differences between the matching variables both before (original sample) and after matching (matched sample)

Fig 3

Results of matched pairs analysis of incisional hernia repair in female vs male patients

Fig. 4

Standardized differences of the influencing factors and the perioperative outcomes between patient collectives with and without follow-up