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Sex-based outcomes after elective open abdominal wall reconstruction: a propensity score-matched analysis
Samantha W Kerr1, Gregory T Scarola1, Sullivan A Ayuso2
1Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Background:
Sex-based differences in hernia outcomes have gained increasing attention, with some emerging evidence suggesting that female patients may experience higher complication rates compared to males for abdominal wall reconstruction (AWR). This study compared perioperative and long-term outcomes between female and male patients undergoing elective hernia repair at a tertiary hernia center.
Methods:
A prospective database at a tertiary AWR program was queried for adults undergoing elective, open AWR. Propensity-score matching (PSM 1:1) was performed for females vs. males based on age, BMI, diabetes, smoking status, CDC wound class, primary versus recurrent repair, defect size, panniculectomy, and mesh type. Standard statistical analyses were performed.
Results:
Among 3764 patients (2152 females; 1612 males), PSM yielded 319 matched pairs. Females and males had similar average BMI (31.2 ± 5.3 vs. 31.1 ± 5.3 kg/m2), diabetes (18.2% vs. 18.2%), smoking status (former: 32.0% vs. 32.0%; current: 2.8% vs. 2.8%), and CDC wound class (I/II: 92.5% vs. 92.5%)(all p > 0.05). Females had higher average age (62.1 ± 12.7 vs. 59.7 ± 11.6 years; p = 0.005). Female and male patients had similar defect size (197.7 ± 154.0 vs. 197.7 ± 152.8 cm2) and mesh size (892.9 ± 537.4 vs. 926.6 ± 486.7 cm2)(each p > 0.05). Most repairs were performed with preperitoneal mesh placement (95.0% vs. 95.9%; p = 0.382). Overall wound complications (15.4% vs. 16.6%; p = 0.666) and average length-of-stay (4.8 ± 3.0 vs. 4.9 ± 4.5 days; p = 0.606) were similar. There was no statistical difference in hernia recurrence (1.9% vs. 1.3%; p = 0.752) over a similar average follow-up (30.5 ± 40.4 vs. 29.3 ± 42.3 months; p = 0.480).
Conclusion:
In this tertiary AWR program, females and males undergoing AWR had no significant differences in short and long-term outcomes when adjusting for comorbidities and operative factors. These findings suggest sex-based differences may be attenuated when patients undergo standardized, preoperative optimization and operative management.