Female Gender and Risk of Ipsilateral Reoperation After Inguinal Hernia Repair: A Cohort Study Including 131,626 Patients in An Integrated Healthcare System Over A 10-Year Period

Abstract

Introduction: The objective of this study is to compare the male and female patients for the risk of reoperation after different repair approaches (open, laparoscopic, and robotic). Methods: We conducted a cohort study of patients ≥18 years who underwent first inguinal hernia repair within a US integrated healthcare system (2010-2020). Multiple Cox proportional-hazards regression was used to evaluate the association between gender and risk for ipsilateral reoperation during follow-up. Analysis stratified by surgical approach (open, laparoscopic, and robotic) with covariate adjustment for potential confounders. Results: The study cohort comprised 131,626 patients who underwent inguinal hernia repair, 10,079 (7.7%) were women. After adjustment for confounders, females had a higher risk of reoperation than males after open repair (hazard ratio [HR]=1.98, 95% CI =1.74-2.25, P < 0.001), but a lower reoperation risk after laparoscopic repair (HR=0.70, 95% CI=0.51-0.97, P = 0.031). The crude 5-year cumulative reoperation probability after robotic repair was 2.8% (95% CI=0.7-4.8) in men and no reoperations were observed for women during follow-up. 0.3% of reoperations in women were for a femoral hernia while only 0.6% were for femoral hernias in men. Conclusion: In a large multi-center cohort of inguinal hernia repair patients, we found a higher risk for reoperation in women after an open repair compared with men which may be due to missed diagnoses of ipsilateral femoral hernias. Lower risk was observed for women through a minimally invasive approach (laparoscopic or robotic) and may be due to the ability to identify an occult femoral hernia through these approaches.