Race and Sex Differences in Postoperative Outcomes After Incarcerated and Strangulated Hernia Repair

Over one million hernia repairs are performed annually in the United States, with more than 20 million worldwide. Although randomized trials support watchful waiting in select cases, delayed repair can lead to strangulation, which is rare but life-threatening. This study examines race and sex-based differences in postoperative outcomes following nonemergent and emergent incarcerated hernia repair.

Retrospective cohort study utilizing National Surgical Quality Improvement Program database (2013-2023). Adults undergoing incarcerated repair were identified using Current Procedural Terminology codes for nonemergent and emergent abdominal wall and inguinal hernias. Outcomes included 30-d complications, readmission, reoperation, and length of stay (LOS). Multivariable regression models assessed associations between race, sex, and postoperative outcomes, adjusting for demographic, clinical, and perioperative covariates. Analyses were stratified on subgroup analysis by operative urgency.

Among 185,791 incarcerated hernia repairs, 159,351 were nonemergent, and 26,440 were emergent. In emergent repairs, race and sex were not associated with 30-d complications, readmissions, or reoperations, though Black and Asian patients experienced longer LOS. In nonemergent repairs, Black and female patients were associated with longer LOS. Female sex was also associated with higher complication rates (odds ratio: 1.145, 95% confidence interval: 1.091-1.201) and readmissions (odds ratio: 1.065, 95% confidence interval: 1.005-1.129). Race was not associated with 30-d complications, readmissions, or reoperations.

Race and sex were not associated with major postoperative outcomes following emergent hernia repair, whereas female sex was associated with increased complications, readmissions, and LOS in nonemergent repair. These findings highlight differences in outcomes by operative urgency and sex.