Preoperative Risk Factors for Poor Hernia-Related Quality of Life One Year After Hernia Repair

Long-term patient-reported outcomes (PROs) after abdominal wall hernia repair (AWHR) are essential for evaluating recovery and informing shared decision-making, yet population-level data and predictors of hernia-related quality of life (QOL) are limited. We measured 1-y postoperative QOL after AWHR and identified preoperative predictors of PROs.

We performed a cohort study using prospectively collected clinical data and 1-y postoperative surveys from the Michigan Surgical Quality Collaborative Core Optimization in Hernia Registry. Adults ≥18 y undergoing AWHR from January 2020 to December 2023 with completed 1-y PRO surveys were included (n = 2867). QOL was measured using Hernia-Related Quality-of-Life tool (2021-2022) or the abdominal hernia questionnaire (AHQ; 2023-2025); Hernia-Related Quality-of-Life scores were standardized and calibrated to the AHQ scale (0-100). Covariates included preoperative demographic, clinical, and hernia-specific characteristics. Weighted unadjusted and adjusted linear regression models estimated associations between risk factors and AHQ scores.

Median (interquartile range) AHQ score was 92.5 (8.1), with a left-skewed distribution (mean [standard deviation], 86.8 [14.4]) and a 10^th percentile score of 66.5. In adjusted models, female sex (versus male; -3.4 points), tobacco use (versus none; -3.6 points), and larger hernia size (e.g., ≥6 cm versus <2 cm; -4.9 points) were associated with lower AHQ score. Older age was associated with higher AHQ score. Race/ethnicity, body mass index, mesh use, and surgical approach were not associated with AHQ score.

Most patients reported high 1-y QOL after AWHR, but a meaningful subset experienced low AHQ scores. Preoperative characteristics may inform counseling and shared decision-making beyond short-term surgical risk.