Female sex as independent risk factor for chronic pain following elective incisional hernia repair: registry-based, propensity score-matched comparison

Abstract

Introduction To date, little attention has been paid by surgical scientific studies to sex as a potential influence factor on the outcome. Therefore, there is a sex bias in the surgical literature. With an incidence of more than 20% after 3 years, incisional hernias are a common complication following abdominal surgical procedures. The proportion of women affected is around 50%. There are very few references in the literature to the influence of sex on the outcome of elective incisional hernia repair. Materials and methods In all, 22,895 patients with elective incisional hernia repair from the Herniamed Registry were included in the study. The patients had undergone elective incisional hernia repair in a laparoscopic IPOM, open sublay, open IPOM, open onlay or suture technique. 1-year follow-up was available for all patients. Propensity score matching was performed for the 11,480 female (50.1%) and 11,415 male (49.9%) patients, creating 8138 pairs (82.0%) within fixed surgical procedures. Results For pain on exertion (11.7% vs 18.3%; p < 0.001), pain at rest (7.53% vs 11.1%; p < 0.001), and pain requiring treatment (5.4% vs 9.1%; p < 0.001) highly significant disadvantages were identified for the female sex when comparing the different results within the matched pairs. That was also confirmed on comparing sex within the individual surgical procedures. No sex-specific differences were identified for the postoperative complications, complication-related reoperations or recurrences. Less favorable intraoperative complication results in the female sex were observed only for the onlay technique. Conclusions Female sex is an independent risk factor for chronic pain after elective incisional hernia repair.

Association of preoperative pain beliefs with postoperative pain levels in abdominal surgery patients

“…The VAS scores of female patients in this study were higher than those of male patients. Similar to our results, existing studies have reported a higher intensity of pain for female patients (Köcklering et al, 2020;López-Alfaro et al, 2019;Wang et al, 2018). The lower VAS scores of male patients in this study may be explained by their belief that men should be more stoic when facing pain (Krupić et al, 2019).…”

“…Although pain is a universal phenomenon, its intensity, experience and expression are subjective and vary among individuals or societies. Such variation, in turn, affects the quality of pain management and patient satisfaction (Bicket et al, 2020;Van Dijk et al, 2017;Köcklering et al, 2020;Subramanian et al, 2016). We found a significant relationship between the PBQ-OB and VAS scores at 24 h postoperatively.…”

Potential influencing factors on the outcome in incisional hernia repair: a registry-based multivariable analysis of 22,895 patients

“…Registry and database analyses reported in the literature make several references to factors that have an unfavorable influence on the outcome following incisional hernia repair [12][13][14][15][16]. These unfavorable factors, include age, gender, risk factors, open surgical procedures, defect width, body mass index (BMI) ≥ 30 kg/m 2 ), and smoking [12][13][14][15][16].…”

“…Registry and database analyses reported in the literature make several references to factors that have an unfavorable influence on the outcome following incisional hernia repair [12][13][14][15][16]. These unfavorable factors, include age, gender, risk factors, open surgical procedures, defect width, body mass index (BMI) ≥ 30 kg/m 2 ), and smoking [12][13][14][15][16]. Recently, an analysis of the data of 2191 patients from the French Hernia Registry "Club Hernie" showed that larger defect widths, as classified by the European Hernia Society (EHS) [17], had an unfavorable impact on the postoperative complication rate [15].…”

Circulating inflammatory biomarkers in adolescents: evidence of interactions between chronic pain and obesity

“… 18 , 29 , 75 Chronic pain is more prevalent in females, and female sex is a risk factor for chronic pain. 38 , 67 Worldwide, the prevalence of obesity is greater in adult females. 1 In the United States, although the prevalence of obesity does not differ by sex, the prevalence of severe obesity (9.2%) in adults is higher in women.…”