Comparison of Outcomes Between Men and Women Undergoing Ventral Hernia Repair

Importance Sex-based differences in ventral hernia repair (VHR) outcomes remain incompletely characterized. Objective To compare short-term clinical outcomes, recurrence through 3 years, and patient-reported outcomes between female and male patients undergoing VHR. Design, Setting, and Participants This cohort study included patients undergoing VHR from January 2012 through December 2023, with follow-up through 3 years. Data were from the Abdominal Core Health Quality Collaborative (ACHQC), a prospective, multi-institutional clinical registry. Participants were adults undergoing primary or incisional VHR whose data were recorded in the ACHQC database. Data analysis was performed from May to September 2026. Exposures Sex (female vs male). Main Outcomes and Measures Primary outcomes included 30-day wound morbidity, comprising surgical site infection (SSI), surgical-site occurrence (SSO), and SSO requiring procedural intervention (SSO-PI), readmission, and length of stay. Secondary outcomes included pragmatic recurrence at 30 days, 1 year, 2 years, and 3 years and patient-reported quality of life and pain. Multivariable logistic regression assessed associations between sex and outcomes. Results Among 31 358 patients, 14 303 (45.6%) were female and 17 055 (54.4%) were male. Women were younger than men (mean [SD] age, 55.0 [14.6] vs 56.5 [13.0] years, respectively) and had higher body mass index (mean [SD], 32.1 [7.6] vs 31.7 [5.9], respectively). Women presented with more complex hernia phenotypes, including higher rates of incisional, recurrent, and larger hernias. Compared with men, women experienced higher 30-day readmission (483 [3.4%] for women vs 428 [2.5%] for men), SSI (370 [2.6%] vs 284 [1.7%], respectively) SSO (1323 [9.2%] and 1286 [7.5%], respectively), and SSO-PI (517 [3.6%] vs 434 [2.5%], respectively; all P < .001), with no differences in reoperation or mortality. Female sex was independently associated with higher odds of SSI (odds ratio [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. Clinical outcomes and recurrence were similar at 1 year; however, women had higher recurrence at 2 years (444 [19.3%] vs 406 [15.7%] men) and 3 years (351 [20.9%] vs 320 [17.6%] men). Women reported worse baseline quality of life and pain but greater improvement after 1 year. Conclusions and Relevance This study found that women undergoing VHR presented with greater hernia complexity and experienced higher early wound morbidity and increased late recurrence, while achieving substantial patient-reported benefit. These findings may inform sex-specific risk stratification and counseling, although further studies with more longitudinal follow-up are needed.