Comparative Outcomes of Groin Hernia Repair by Sex Among Medicare Beneficiaries.

Objective: To compare the rates of operative recurrence between male and female patients undergoing groin hernia repair.
Background Data: Groin hernia repair is common but understudied in females. Limited prior work demonstrates worse outcomes among females.
Methods: Using Medicare claims, we performed a retrospective cohort study of adult patients who underwent elective groin hernia repair between January 1, 2010 and December 31, 2017. We used a Cox proportional hazards model to evaluate the risk of operative recurrence up to 5 years following the index operation. Secondary outcomes included 30-day complications following surgery.
Results: Among 118,119 patients, females comprised the minority of patients (n=16,056, 13.6%). Compared with males, female patients were older (74.8 vs. 71.9 y, P <0.01), more often white (89.5% vs. 86.7%, P <0.01), and had a higher prevalence of nearly all measured comorbidities. In the multivariable Cox proportional hazards model, we found that female patients had a significantly lower risk of operative recurrence at 5-year follow-up compared with males (aHR 0.70, 95% CI 0.60-0.82). The estimated cumulative incidence of recurrence was lower among females at all time points: 1 year [0.68% (0.67-0.68) vs. 0.88% (0.88-0.89)], 3 years [1.91% (1.89-1.92) vs. 2.49% (2.47-2.5)], and 5 years [2.85% (2.82-2.88) vs. 3.7% (3.68-3.75)]. We found no significant difference in the 30-day risk of complications.
Conclusions: We found that female patients experienced a lower risk of operative hernia recurrence following elective groin hernia repair, which is contrary to what is often reported in the literature. However, the risk of operative recurrence was low overall, indicating excellent surgical outcomes among older adults for this common surgical condition.
Competing Interests: A.P.E. receives related funding from SAGES, and unrelated funding from the Blue Cross Blue Shield of Michigan Foundation and the Association for Academic Surgery. R.H. receives unrelated funding from the Blue Cross Blue Shield of Michigan Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK108740-05). D.A.T. receives unrelated funding from the National Institute of Diabetes and Digestive and Kidney Diseases and receives consulting fees from Medtronic. J.B.D. receives unrelated grant funding from the National Institutes of Health, the Agency for Healthcare Research and Quality, Blue Cross Blue Shield of Michigan Foundation, and is a cofounder of ArborMetrix, Inc. The remaining authors do not have any disclosures. No funder had any part in the design or execution of this study. The remaining authors report no conflicts of interest.
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