Abstract
Purpose:
To assess sex differences in patient-reported quality of life, pain, and hernia recurrence after adjusting for confounding features of hernia disease, in a large national registry one year after ventral hernia repair.
Methods:
Data were analyzed retrospectively from the Abdominal Core Health Quality Collaborative national registry from pre-operatively until one year post-operatively. 3,172 patients undergoing elective ventral hernia repair with 1-year follow-up data were included for analysis after propensity score matching (1:1 match; females: mean [standard deviation] age, 60 [49,68]; body mass index, 32 [27, 36]; males: age, 60 [52, 68]; 31 [28, 35]. The primary outcome of interest between sexes was the Hernia Related Quality of Life survey, and secondary outcome measures included the Patient-Reported Outcomes Measurement Information System Pain Intensity short form (3a) score and hernia recurrence.
Results:
Female sex was associated with worse HerQLes and PROMIS pain 3a scores at 1 year follow up (adjusted mean difference, −2.42, 95% confidence interval (CI) −4.11 to −0.72; p=0.004; adjusted mean difference, 1.27, 95% CI 0.67 to 1.87; p<0.001) compared to male sex. Hernia recurrence rates at 1 year were not different between sexes.
Conclusion:
Females reported worse quality of life and higher levels of pain at 1-year post ventral hernia repair after accounting for age, BMI, hernia width, and baseline quality of life compared to males. There were no differences between females and males with respect to hernia recurrence at 1-year follow-up, and 1 in 5 patients experienced a recurrence at this time point.
Keywords: Ventral hernia, sex differences, quality of life, post-operative pain
INTRODUCTION
The number of ventral hernia repairs continues to rise within the United States, with recent data indicating over 600,000 repairs each year.[22] Post-operative outcomes demonstrate challenges with pain, with 26% of overall patients reporting chronic discomfort at 1 year post-operatively.[5] Similarly, recurrence rates are high, ranging from 24%–63% in individuals with ventral hernia, and recurrent hernias are linked to poor short and long-term outcomes.[4, 5, 13, 20]. Consensus statements from basic science and clinical researchers have emphasized the importance of sex and gender differences in the study of pain and analgesia.[7] Understanding how outcomes in male and female patients may differ after ventral hernia repair may provide further insight into patterns of recovery across patients.
A significant difference in outcomes between sexes across various types of hernia repairs is evident, where female sex consistently relates to poorer outcomes, though previous studies have focused on less complicated procedures.[5, 6, 9, 21, 23] In the early 2000s, a prospective analysis of the Swedish Hernia Registry assessed sex differences in outcomes after inguinal hernia repairs and found that females had a significantly higher risk of reoperation due to hernia recurrence compared to males.[11] Similarly, prospective studies comparing differences in early postoperative experiences after undergoing laparoscopic hernia repair showed females experienced more pain, discomfort, and fatigue compared with males[23] and higher readmission rates to the hospital.[9]
A small but growing body of literature indicates that female sex is also associated with worse outcomes following ventral hernia repair. Specific to patients with ventral hernia disease, Craig et al. found in a retrospective community hospital analysis that female sex was an independent predictor of post-operative hernia infections.[6] Further, a prospective analysis of ventral hernia repair patients within the International Hernia Mesh Registry built a predictive model showing that female sex, younger age, and recurrent hernias predicted both short- and long-term post-operative pain, re-iterating the importance of understanding sex-specific outcomes in this population.[5] Confounding factors in these studies, such as inherent differences in male and female study samples, make it difficult to understand the isolated effects of sex as a predictor of poor outcomes. Further, current literature does not consider patient-reported quality of life when assessing the impact that sex has on outcomes after hernia repairs. It is important to understand if sex, after adjusting for potential confounding features of hernia disease, similarly affects pain, hernia recurrence, and patient-reported quality of life to continue to uncover clinically relevant sex differences that help guide post-operative decision-making.
Single site, non-randomized, small sample database studies predominate the literature examining sex differences in post-surgical outcomes. Further, patient-reported quality of life is not often used as an outcome when assessing sex differences in outcomes. Therefore, the purpose of this study was to leverage a multi-center registry database with contributing surgeons from across the United States to compare post-surgical outcomes between males and females one year after surgery. We hypothesized that females would demonstrate worse quality of life and pain, and higher hernia recurrence after accounting for baseline patient status.
METHODS
Data Source
Data were pulled retrospectively from the Abdominal Core Health Quality Collaborative (ACHQC), recognized previously as a CMS qualified Clinical Data Registry.[16] The ACHQC is a national registry developed primarily for quality improvement. At the time of this analysis (June 2023), data were available from over 114,000 patients and over 400 surgeons.
Patients Included
The primary purpose of the analysis was to assess sex differences in patient-reported quality of life, pain, and hernia recurrence one year after ventral hernia repair. Patients undergoing elective ventral hernia repair with 1-year follow-up data were identified. Of these patients, individuals were included in the study if their primary diagnosis was a ventral hernia repair, this was an elective repair, sex data and operative data were available, and baseline and 1-year post-operative Hernia-Related Quality of Life (HerQLes) data were available (Figure 1).
Figure 1.
Analytical cohort before and after inclusion/exclusion criteria were applied.
Outcomes of Interest
The HerQLes summary score at 1 year was the primary outcome variable of interest. The HerQLes is a valid and reliable 12-item 6-point Likert-style survey assessing quality of life in patients with hernia disease.[12] HerQLes scores were calculated using the formula: (120-[(20/12)*(sum of response on all 12 questions)]). Scores range from 0–100, and a higher HerQLes score indicates a better patient-reported quality of life. The Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity short form (3a) score and hernia recurrence at 1-year follow-up were secondary outcomes of interest. The PROMIS questionnaire was designed by the National Institutes of Health and is both valid and reliable.[19] PROMIS Pain Intensity short form (3a) T scores were calculated in accordance to the PROMIS pain intensity instrument guidelines, and range from a T score of 30.7–71.8, where higher scores indicate more self-reported pain.[19] Hernia recurrence was defined as either a clinical (physical examination), radiographic (computed tomography), or patient-reported (hernia recurrence index)[3] recurrence event at 1-year post-operatively.
Statistical Analysis
Baseline characteristics were compared between female sex and male sex using Wilcoxon rank sum, Pearson Chi-squared test, and Fisher exact test where appropriate. To control for any confounding variables, one-to-one propensity score matching (PSM) based on a logistic regression model was done on pre-selected baseline patient-related and operative factors, listed below. Nearest neighbor with caliper 0.2 standard deviation of the propensity score was used. Sixty-six patients (1.7%) were excluded from the PSM analysis due to missing values in covariates which were included in the PSM model. The covariates were demographics (i.e., age, BMI, race), features of hernia disease (i.e., width, length, type), HerQLes summary score at baseline, ASA class, comorbidities (i.e., current smoker, hypertension, diabetes mellitus, chronic obstructive pulmonary disease (COPD), dyspnea), medication use (i.e., anti-platelet medications, anti-coagulation medications, immunosuppressants), currently active infection, history of abdominal wall SSI, hernia recurrent, and surgical parameters (i.e., OR time > 2hours, wound status, operative approach, mesh used and type). The balance of these variables between female sex and male sex were evaluated using standardized mean differences (SMDs), where SMD less than 0.1 or even 0.2 was considered acceptable.
Following PSM, linear regression models were used to assess the association between sex and patient reported outcomes of HerQLes scores and PROMIS pain scores at 1 year follow-up. The model was adjusted for age, body mass index (BMI), baseline HerQLes scores, hernia width, and recurrent hernia status prior to surgery. A two-sided p-value ≤0.05 was considered statistically significant. All analyses were conducted using R version 4.1 (R Project for Statistical Computing).
RESULTS
After excluding patients who did not meet inclusion and exclusion criteria and missing patients, 3,172 patients were included for analysis (Table 1). After PSM, male and female groups were balanced with all standardized mean differences <0.15 (Figure 2).
Table 1.
Participant demographics. Values are median (interquartile range [IQR]) unless otherwise specified.
| Matched | Unmatched | |||||
|---|---|---|---|---|---|---|
|
| ||||||
| Male (n=1586) | Female (n=1586) | p-value | Male (n = 1963) | Female (n = 1908) | p-value | |
| Age (years) | 60 (52,68) | 60 (49,68) | 0.05 | 61 (52,68) | 59 (49,67) | <0.001 |
| BMI (kg/m2) | 31 (28, 35) | 32 (27, 36) | 0.087 | 31 (28, 35) | 32 (27,36) | 0.013 |
| ASA Class, % (n) | 0.27 | 0.25 | ||||
| 1 | 4 (84) | 5 (101) | 4 (61) | 5 (84) | ||
| 2 | 35 (684) | 33 (626) | 32 (511) | 32 (513) | ||
| 3 | 58 (1145) | 60 (1141) | 62 (982) | 61 (961) | ||
| 4 | 2 (39) | 2 (34) | 2 (32) | 2 (28) | ||
| 5 | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| None | 1 (11) | 0 (6) | 0 (0) | 0 (0) | ||
| Race, % non-white (n) | 7 (128) | 10 (192) | <0.001 | 7 (116) | 9 (145) | 0.061 |
| Hernia width (cm) | 9 (3,15) | 9 (4,15) | 0.94 | 7 (2,14) | 9 (4,15) | <0.001 |
| Hernia length (cm) | 15 (4,23) | 15 (4, 22) | 0.53 | 11 (3,21) | 15 (5,22) | <0.001 |
| Concomitant procedure %yes (n) | 15 (232) | 16 (258) | 0.2 | 13 (263) | 17 (316) | 0.006 |
| Operative approach, %(n) | 1.0 | 0.78 | ||||
| Open | 75 (1184) | 74 (1177) | 74 (1453) | 73 (1386) | ||
| Laparoscopic | 6 (88) | 6 (90) | 6 (121) | 6 (114) | ||
| MIS convert to open | 1 (16) | 1 (14) | 1 (17) | 1 (17) | ||
| Robotic | 15 (239) | 15 (242) | 15 (302) | 16 (310) | ||
| Laparoscopy-assisted ventral hernia repair | 1 (17) | 1 (17) | 1 (23) | 1 (22) | ||
| Robotic-assisted ventral hernia repair | 3 (42) | 3 (46) | 2 (47) | 3 (59) | ||
| Mesh Used , % yes (n) | 92 (1455) | 92 (1454) | 0.95 | 91 (1796) | 92 (1746) | 0.98 |
| Mesh Type, %(n) | 0.78 | 0.28 | ||||
| Permanent Synthetic | 88 (1388) | 87 (1384) | 88 (1725) | 87 (1662) | ||
| Biological Tissue-Derived | 3 (43) | 2 (39) | 2 (45) | 2 (43) | ||
| Resorbable Synthetic | 2 (24) | 2 (31) | 1 (26) | 2 (41) | ||
| No mesh used | 8 (131) | 8 (132) | 9 (167) | 8 (162) | ||
BMI, body mass index; ASA, American Society of Anesthesiologists
Figure 2.
Balanced groups shown using standardized mean differences for male and female sex before (red) and after (blue) propensity score matching.
Hernia Related Quality of Life (HerQLes) Scores
Female sex was associated with worse HerQLes scores at 1-year follow-up (adjusted mean difference, −2.42, 95% confidence interval (CI) −4.11 to −0.72; p=0.004) compared to male sex (Table 2, Figure 3). Females reported a median score of 83 (57,95) while males reported a median score of 87 (65, 95).
Table 2.
HerQLes quality of life summary scores, PROMIS Pain 3a, hernia recurrence, SSI/SSO, and re-operation at 1 year post-operatively before and after propensity score matching. Values are median (interquartile range [IQR]) unless otherwise specified.
| Matched | Unmatched | |||||
|---|---|---|---|---|---|---|
|
| ||||||
| Male (n=1586) | Female (n=1586) | p-value | Male (n = 1963) | Female (n = 1908) | p-value | |
| HerQLes- Baseline | 43 (25,68) | 40 (20,63) | 0.001 | 50 (28,75) | 38 (18,62) | <0.001 |
| HerQLes- One Year | 87 (65,95) | 83 (57,95) | 0.004 | 90 (69,97) | 83 (55,95) | <0.001 |
| PROMIS Pain 3a -Baseline | 44 (31,52) | 46 (40,52) | <0.001 | 44 (31,49) | 46 (40,52) | <0.001 |
| PROMIS Pain 3a- One Year | 31 (31,44) | 31 (31,46) | <0.001 | 31 (31,44) | 36 (31,46) | <0.001 |
| Composite Recurrence- One Year, %yes (n) | 20 (323) | 22 (351) | 0.22 | 18 (353) | 23 (430) | <0.001 |
| SSO/I- One Year, %yes (n) | 3 (18) | 2 (14) | 0.4 | 3 (19) | 3 (19) | 0.8 |
| Re-operation- One Year, %yes (n) | 5 (29) | 3 (21) | 0.2 | 5 (31) | 4 (27) | 0.4 |
HerQLes, hernia related quality of life; PROMIS, Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity short form (3a); SSI, surgical site infection; SSO, surgical site occurrence.
Figure 3.
HerQLes (top) and PROMIS Pain 3a (bottom) scores at one year post-operatively. Data presented as median (interquartile range). Lower HerQLes scores represent worse self-reported quality of life, higher PROMIS Pain 3a scores represent more pain.
PROMIS Pain 3a Scores
Female sex was also associated with worse PROMIS pain 3a scores at 1-year follow-up (adjusted mean difference, 1.27, 95% CI 0.67 to 1.87; p<0.001) compared to male sex. Females reported a median score of 31 (31, 46), and males also reported a median score of 31 (31,44) (Table 2, Figure 3).
Hernia Recurrence
Hernia recurrence rates at 1 year were not different between sexes (female vs male: 22% versus 20%, p=0.2; Table 2).
DISCUSSION
The purpose of this study was to assess post-surgical outcomes in quality of life, pain, and hernia recurrence in males and females 1 year after surgery using a multi-center registry database. Our hypothesis that females would demonstrate worse post-surgical outcomes was partially confirmed, with females experiencing higher levels of pain and lower self-reported quality of life compared to their male counterparts after propensity score matching and accounting for baseline patient status. Females and males were not different in the percentage experiencing hernia recurrence 1 year after surgery. Collectively, these data indicate that female sex may be a negative prognostic factor for worse outcomes 1 year after ventral hernia repair.
This study was one of the first to examine sex differences in patient-reported quality of life after ventral hernia repair using the HerQLes. The HerQLes was developed in 2012 as a more population-specific target of quality of life compared to other common instruments like the Short Form-36 (SF-36) which assesses more wide-scale populations over time.[12] Median scores on the HerQLes patient-reported outcome tool showed a mean difference of 4 at 1 year post-operatively favoring male participants. Using 1817 patients enrolled in the ACHQC data registry, the minimal clinically important difference (MCID) for the HerQLes was established by Renshaw et al. as a change in score of at least 15.6 points from pre-operative status to 1-year post-operatively.[17] In our current sample, both males (pre-operative HerQLes: 43 (25,68)) and females (pre-operative HerQLes: 40 (20,63)) achieved that MCID between baseline and 1 year, but it is unclear if the mean difference of 4 between sexes at 1 year is clinically meaningful. The intent of the HerQLes was to assess quality of life specifically as it relates to function, asking questions related to walking, stair climbing, moderate and strenuous activities, and activities of daily function.[12] To better understand how recovery from ventral hernia repair may affect males and females differently, objective measures of physical function may be required.
It is unclear why females may experience worse pain and function following VHR, and to our knowledge this is the only study that has assessed sex differences in the HerQLes. Studies of other clinical conditions also demonstrate that female sex confers worse pre- and post-operative outcomes. In individuals with osteoarthritis (OA), females who are candidates to receive a total knee arthroplasty (TKA) have significant functional impairments (e.g., worse muscle weakness and stair climbing) than males.[10, 15] Post-operatively, females report more acute postoperative pain[14] and demonstrate significant functional decline on standardized tests such as the Timed Up and Go (TUG), stair climbing test, and 6-minute walk test, but not in muscle strength.[8] These clinical findings corroborate the same need to further identify the unique needs females may have across clinical conditions and the necessity to consider sex as a factor when studying post-operative outcomes. Further research is required to understand the differences in perception of health and quality of life in female patients after ventral hernia repair, and if they relate to objective measures of physical function post-operatively. Understanding the differences in functional outcomes will enable the development of more effective and tailored clinical interventions for female patients after ventral hernia repair.
The secondary findings of this study, that females experienced higher levels of pain but not higher rates of recurrence 1 year after surgery suggest females may be more symptomatic but there may not be a direct structural explanation for this (i.e., hernia recurrence). These sex differences in pain are concerning, particularly because a higher prevalence of early postoperative pain may lead to more medication use postoperatively.[24] PROMIS scores have a mean of 50 and standard deviation of 10 in a reference population (e.g., US general population). Scores in the low 30s suggest that one year post-operatively both males and females are reporting low pain levels. Similar to the HerQLes, it is unclear the clinical meaningfulness of the statistically significant difference between males and females and their pain ratings a 1 year post-operatively.
There was no significant difference between males and females with respect to recurrence rates at 1 year in the matched sample (males: 20 (323), females: 22 (351)), however in the unmatched sample females did demonstrate a significantly higher recurrence rate than males (23% vs 18%, respectively). Recurrence rates in previous literature for ventral hernia repair are up to 32% within 10 years post-operatively[1, 2], which is higher than the rates in this study but over a much longer period of time. Recurrence rates alone may underestimate the functional and self-reported disability seen in this patient population. More studies assessing objective function, pain, and self-reported function are necessary to understand the likely multi-factorial nature of recovery after ventral hernia repair.
To further understand these sex-specific relationships, objectively measuring function along the trajectory of recovery from surgery is necessary. Studies have assessed long-term functional outcomes previously but are primarily limited to self-reported measures like the SF-36, Activities Assessment Scale, and visual analogue scales. While these may capture self-reported physical function and bodily pain, directly measuring function using clinical tools such as the PROMIS-PF scale, five time sit-to-stand, timed up and go, and other measures provide a more objective functional measurement wherein clinicians can track changes in function over time more directly. These tools allow clinicians to test function in a way that replicates their activities of daily living, and ask questions directly related to their unique functional goals. Further, the addition of post-operative rehabilitation may help to improve both functional and self-reported outcomes in these individuals.
In this same registry cohort, the impact of pre-operative physical activity levels on changes in quality of life and pain from baseline to 30-days post-operatively was investigated.[18] Results suggested that, after adjusting for confounding factors, patients who had higher exercise frequency pre-operatively experienced lower odds of postoperative complications and lower odds of readmission.[18] While no associations were found between exercise level and quality of life or pain from baseline to 30-days,[18] future work is needed to assess longer-term relationships (i.e., 1 year post-operatively) and the addition of postoperative physical activity and guided activity prescription for improving outcomes. Findings from the ACHQC registry in this analysis suggest it is important that future studies assessing outcomes after ventral hernia repair consider sex-specific analyses. Future research is necessary to identify modifiable risk factors that may explain this post-operative sex difference. Different clinical treatment targets may be warranted for female and male patients respectively.
There are some limitations to address when interpreting this work. This analysis was limited to patients who underwent elective ventral hernia repair and cannot be generalized to other types of hernia repairs or emergency situations. All outcome measures (HerQLes, PROMIS 3a, and recurrence) are subject to recall bias, and objective measurements of function and pain intensity during functional tasks may be more representative of the sample. There is no MCID for PROMIS in individuals with ventral hernia disease, so it is unclear if the mean difference between sexes in this study is clinically meaningful. Recurrence has been represented in a variety of ways in the literature and caution should be applied in interpreting the results of our operational definition of recurrence. Finally, propensity score matching as a method to reduce bias in non-randomized data may introduce unobservable factors when balancing the data. Groups created through propensity score matching are not necessarily representative of the general population of male or female patients with ventral hernia disease, and this may underestimate differences in prognosis between sexes.
CONCLUSION
Females reported significantly lower quality of life and higher levels of pain at 1-year post ventral hernia repair after accounting for age, BMI, hernia width, and baseline quality of life compared to males, though it is unclear whether these group differences are clinically meaningful. There were no differences between females and males with respect to hernia recurrence at 1-year follow-up, and 1 in 5 patients experienced a recurrence at this time point. Female sex may be a negative prognostic factor for outcomes 1-year after ventral hernia repair, though the mechanism of effect remains unclear.
ACKNOWLEDGEMENTS
The authors would like to acknowledge our participants and study team members Laura Ward, PT, DPT; Savannah Renshaw, MPH; Kiana Shannon; Peter Edwards; Courtney Collins, MD; and David Renton, MD. This work was supported by grants from the National Institute of Diabetes Digestive and Kidney Diseases (R01DK131207 and F32DK137486). This work was also supported by in-kind administrative funding from the Abdominal Core Health Quality Collaborative (ACHQC) and by The Ohio State University Center for Clinical and Translational Science, which receives financial support from the National Center for Advancing Translational Sciences (NCATS; UL1TR002733).
Footnotes
Ethics approval: This study used de-identified data from a national database. The institutional review board of The Ohio State University provided a waiver of ethical approval for this study. Informed consent was obtained by the international review board at The Ohio State University. This study did not directly involve humans or animals as it was obtained from a national database.
REFERENCES
- 1.Awad ZT, Puri V, LeBlanc K, Stoppa R, Fitzgibbons RJ, Iqbal A, Filipi CJ (2005) Mechanisms of Ventral Hernia Recurrence after Mesh Repair and a New Proposed Classification. J Am Coll Surg 201:132–140. doi: 10.1016/j.jamcollsurg.2005.02.035 [DOI] [PubMed] [Google Scholar]
- 2.Ballem N, Parikh R, Berber E, Siperstein A (2008) Laparoscopic versus open ventral hernia repairs: 5 year recurrence rates. Surg Endosc 22:1935–1940. doi: 10.1007/s00464-008-9981-1 [DOI] [PubMed] [Google Scholar]
- 3.Baucom RB, Ousley J, Feurer ID, Beveridge GB, Pierce RA, Holzman MD, Sharp KW, Poulose BK (2016) Patient reported outcomes after incisional hernia repair-establishing the ventral hernia recurrence inventory. Am J Surg 212:81–88. doi: 10.1016/j.amjsurg.2015.06.007 [DOI] [PubMed] [Google Scholar]
- 4.Burger JWA, Luijendijk RW, Hop WCJ, Halm JA, Verdaasdonk EGG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–583; discussion 583–585. doi: 10.1097/01.sla.0000141193.08524.e7 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Cox TC, Huntington CR, Blair LJ, Prasad T, Lincourt AE, Heniford BT, Augenstein VA (2016) Predictive modeling for chronic pain after ventral hernia repair. Am J Surg 212:501–510. doi: 10.1016/j.amjsurg.2016.02.021 [DOI] [PubMed] [Google Scholar]
- 6.Craig P, Parikh PP, Markert R, Saxe J (2016) Prevalence and Predictors of Hernia Infection: Does Gender Matter? Am Surg 82:E93–95 [PubMed] [Google Scholar]
- 7.Greenspan JD, Craft RM, LeResche L, Arendt-Nielsen L, Berkley KJ, Fillingim RB, Gold MS, Holdcroft A, Lautenbacher S, Mayer EA, Mogil JS, Murphy AZ, Traub RJ (2007) Studying sex and gender differences in pain and analgesia: A consensus report. Pain 132:S26–S45. doi: 10.1016/j.pain.2007.10.014 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Gustavson AM, Wolfe P, Falvey JR, Eckhoff DG, Toth MJ, Stevens-Lapsley JE (2016) Men and Women Demonstrate Differences in Early Functional Recovery After Total Knee Arthroplasty. Arch Phys Med Rehabil 97:1154–1162. doi: 10.1016/j.apmr.2016.03.007 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Helgstrand F, Jørgensen LN, Rosenberg J, Kehlet H, Bisgaard T (2013) Nationwide prospective study on readmission after umbilical or epigastric hernia repair. Hernia J Hernias Abdom Wall Surg 17:487–492. doi: 10.1007/s10029-013-1120-9 [DOI] [PubMed] [Google Scholar]
- 10.Kennedy D, Stratford PW, Pagura SMC, Walsh M, Woodhouse LJ (2002) Comparison of gender and group differences in self-report and physical performance measures in total hip and knee arthroplasty candidates. J Arthroplasty 17:70–77. doi: 10.1054/arth.2002.29324 [DOI] [PubMed] [Google Scholar]
- 11.Koch A, Edwards A, Haapaniemi S, Nordin P, Kald A (2005) Prospective evaluation of 6895 groin hernia repairs in women. Br J Surg 92:1553–1558. doi: 10.1002/bjs.5156 [DOI] [PubMed] [Google Scholar]
- 12.Krpata DM, Schmotzer BJ, Flocke S, Jin J, Blatnik JA, Ermlich B, Novitsky YW, Rosen MJ (2012) Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg 215:635–642. doi: 10.1016/j.jamcollsurg.2012.06.412 [DOI] [PubMed] [Google Scholar]
- 13.Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398. doi: 10.1056/NEJM200008103430603 [DOI] [PubMed] [Google Scholar]
- 14.Nandi M, Schreiber KL, Martel MO, Cornelius M, Campbell CM, Haythornthwaite JA, Smith MT, Wright J, Aglio LS, Strichartz G, Edwards RR (2019) Sex differences in negative affect and postoperative pain in patients undergoing total knee arthroplasty. Biol Sex Differ 10:23. doi: 10.1186/s13293-019-0237-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Petterson SC, Raisis L, Bodenstab A, Snyder-Mackler L (2007) Disease-Specific Gender Differences Among Total Knee Arthroplasty Candidates. JBJS 89:2327. doi: 10.2106/JBJS.F.01144 [DOI] [PubMed] [Google Scholar]
- 16.Poulose BK, Roll S, Murphy JW, Matthews BD, Todd Heniford B, Voeller G, Hope WW, Goldblatt MI, Adrales GL, Rosen MJ (2016) Design and implementation of the Americas Hernia Society Quality Collaborative (AHSQC): improving value in hernia care. Hernia J Hernias Abdom Wall Surg 20:177–189. doi: 10.1007/s10029-016-1477-7 [DOI] [PubMed] [Google Scholar]
- 17.Renshaw SM, Gupta A, Poulose BK (2022) Establishing the minimal clinically important difference for the Hernia-Related Quality of Life Survey (HerQLes). Am J Surg 223:245–249. doi: 10.1016/j.amjsurg.2021.06.018 [DOI] [PubMed] [Google Scholar]
- 18.Renshaw SM, Poulose BK, Gupta A, Di Stasi S, Chaudhari A, Collins C (2021) Preoperative exercise and outcomes after ventral hernia repair: Making the case for prehabilitation in ventral hernia patients. Surgery 170:516–524. doi: 10.1016/j.surg.2021.03.006 [DOI] [PubMed] [Google Scholar]
- 19.Revicki DA, Chen W-H, Harnam N, Cook KF, Amtmann D, Callahan LF, Jensen MP, Keefe FJ (2009) Development and psychometric analysis of the PROMIS pain behavior item bank. PAIN 146:158. doi: 10.1016/j.pain.2009.07.029 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Rosen MJ, Krpata DM, Ermlich B, Blatnik JA (2013) A 5-Year Clinical Experience With Single-Staged Repairs of Infected and Contaminated Abdominal Wall Defects Utilizing Biologic Mesh. Ann Surg 257:991. doi: 10.1097/SLA.0b013e3182849871 [DOI] [PubMed] [Google Scholar]
- 21.Schlosser KA, Maloney SR, Thielan O, Prasad T, Kercher K, Colavita PD, Heniford BT, Augenstein VA (2020) Outcomes specific to patient sex after open ventral hernia repair. Surgery 167:614–619. doi: 10.1016/j.surg.2019.11.016 [DOI] [PubMed] [Google Scholar]
- 22.Schlosser KA, Renshaw SM, Tamer RM, Strassels SA, Poulose BK (2023) Ventral hernia repair: an increasing burden affecting abdominal core health. Hernia 27:415–421. doi: 10.1007/s10029-022-02707-6 [DOI] [PubMed] [Google Scholar]
- 23.Tolver MA, Strandfelt P, Rosenberg J, Bisgaard T (2013) Female gender is a risk factor for pain, discomfort, and fatigue after laparoscopic groin hernia repair. Hernia J Hernias Abdom Wall Surg 17:321–327. doi: 10.1007/s10029-012-0956-8 [DOI] [PubMed] [Google Scholar]
- 24.Turner JA, Shortreed SM, Saunders KW, LeResche L, Von Korff M (2016) Association of levels of opioid use with pain and activity interference among patients initiating chronic opioid therapy: a longitudinal study. PAIN 157:849. doi: 10.1097/j.pain.0000000000000452 [DOI] [PMC free article] [PubMed] [Google Scholar]