Evolving Inguinal Hernia Repair Practice at the Veterans Health Administration

Inguinal hernia repair (IHR) is one of the most commonly performed operations in the United States, with approximately 800 000 performed each year. US veterans are a unique group that is predominantly male and tends to have higher rates of medical comorbidities and tobacco use, common risk factors for hernia development. With significant advancements in IHR technique in recent years, the majority of national database studies have focused on civilian populations.

To examine trends and the evolution of IHR within the Veterans Health Administration (VHA) over the past 20 years.

This cohort study examined national data retrospectively from all VHA institutions in the period 2002 to 2022. Participants were veterans who received IHR within the VHA were identified through the Corporate Data Warehouse using procedure and diagnosis codes. Data were analyzed from January to April 2025.

Inguinal hernia repair.

Surgical volumes and trends in IHR surgical approach across the VHA were examined over time. Additional measures included procedural urgency and surgical setting.

A total of 308 876 veterans underwent IHR from 2002 to 2022. Patients were predominantly male (306 905 [99.4%]; 1971 female patients [0.6%]), with a median (IQR) age of 65 (57-73) years. They had high rates of hypertension (198 792 [64.4%]), depression (102 880 [33.3%]), chronic obstructive pulmonary disease (82 608 [26.7%]) and alcohol use disorder (68 427 [22.2%]). A total of 60 088 patients (19.5%) underwent minimally invasive (MIS) IHR while 246 403 procedures (79.8%) were open. Most were outpatient (300 400 [97.3%]); only 17 352 (5.6%) were urgent or emergent. Compared with men, women were more likely to undergo MIS-IHR (452 women [22.9%] vs 59 636 men [19.4%]) and urgent/emergent procedures (218 women [11.1%] vs 17 134 men [5.6%]). Annual IHR volume increased from 12 086 in 2002 to 17 897 in 2022, with an increase in MIS-IHR from 1102 (9.2%) to 7286 (41.0%). After a decline during COVID-19, IHR numbers have since recovered and surpassed pre-2020 volume. Throughout the study period, IHRs performed in the community were more likely to be urgent or emergent cases (1015 [28.1%] vs 16 337 [5.4%] in Veterans Affairs [VA] facilities).

This study found that over the past 20 years, the volume of IHRs performed in the VHA system has increased, along with MIS approaches. Hernia repairs are a significant surgical burden within the veteran population, reflecting the evolving surgical practices and needs of this unique demographic.