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

A Koch,H Hoffmann,W Reinpold,P Kirchhoff,D Adolf,D.weyhe D.Weyhe,F Köckerling

doi:10.1007/s10029-019-02089-2

Abstract

IntroductionTo 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 methodsIn 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.ResultsFor 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.ConclusionsFemale sex is an independent risk factor for chronic pain after elective incisional hernia repair.

Highlights

To date, little attention has been paid by surgical scientific studies to sex as a potential influence factor on the outcome
As part of the information provided to patients regarding participation in the herniamed hernia registry and signing the informed consent declaration all patients are informed that the treating hospital or medical practice would like to be informed about any problem occurring after the operation and that the patient has the opportunity to attend clinical examination [17]
Whereas for inguinal hernia sex differences were only recently recompiled [16, 22], there is a paucity of publications on the influence of sex on the outcome after ventral- and incisional hernia-repair [12, 13]

Summary

Introduction

Little attention has been paid by surgical scientific studies to sex as a potential influence factor on the outcome. Materials and methods In all, 22,895 patients with elective incisional hernia repair from the Herniamed Registry were included in the study. Conclusions Female sex is an independent risk factor for chronic pain after elective incisional hernia repair. In registry studies there is essentially no difference between the proportion of men and women in the total collective of incisional hernias, with each accounting for 50% [8,9,10,11]. There are very few references in the literature to the influence of sex on the outcome of elective incisional hernia repair.

Methods

Results

Conclusion