Abstract
Background
Male and female hernia patients often have different surgical history, fat distribution,
and medical comorbidities. Female surgical patients seemingly experience worse outcomes
after open ventral hernia repair. This study evaluates the impact of sex and the distribution
of abdominal adiposity on outcomes after open ventral hernia repair.
Methods
A prospective hernia database was queried for patients from 2007 to 2018 with a computed
tomography within 1 year of open ventral hernia repair. Three-dimensional volumetric
analysis was performed. Demographics, abdominal fat distribution, operative characteristics,
and outcomes were evaluated by sex using univariate and multivariate analysis.
Results
A total of 1,178 patients were identified, 57.8% were female. Compared with males,
females had higher mean body mass index (34.8 ± 8.5 vs 31.7 ± 6.4 kg/m2, P < .0001), previous abdominal operations (3.3 ± 1.5 vs 2.6 ± 1.3, P < .0001), and preoperative chronic pain (33.5 vs 26.4%, P = .009). There was no difference in history of recurrence, age, steroid use, smoking,
diabetes, or hernia volume between sexes (P ≥ .17 all values). Males had larger defects (168.1 ± 148.2 vs 138.8 ± 126.8 cm2, P = .001) and intra-abdominal volume (intra-abdominal fat volume; 6,279 ± 2,614 vs 4,454
± 2,196 cm3, P < .0001). Females had larger subcutaneous fat volume (subcutaneous fat volume; 7,453
± 6,600 vs 5,708 ± 3,275 cm3, P < .0001), and ratio of hernia to intra-abdominal volume (hernia volume to intra-abdominal
fat volume; 0.33 ± 0.52 vs 0.22 ± 0.42, P < .0001). On univariate analysis, females had higher rates of readmission, wound complication,
and intervention for pain after open ventral hernia repair (P ≤ .02 all values). On multivariate analysis, females had shorter duration of stay
(–1.36 day, standard error 0.49, P = .006) with higher readmission rate (odd ratio, 1.64; 95% confidence interval, 1.15–2.34).
Conclusion
Female hernia patients in our population are more comorbid, with higher body mass
index, thicker subcutaneous fat volume and a higher ratio of hernia volume to intra-abdominal
fat volume. These differences are associated with more extensive surgical intervention,
such as panniculectomy and higher rates of adverse outcomes after open ventral hernia
repair. However, these differences are not fully explained by identified comorbidities
and warrant further investigation.
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Article info
Publication history
Published online: December 26, 2019
Accepted:
November 11,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
