Advertisement

Hernia

pp 1–9 | Cite as

Risk factors for repeat hernia repair in women of childbearing age

  • M. LouieEmail author
  • P. D. Strassle
  • J. K. Moulder
  • W. Overby
Original Article
  • 32 Downloads

Abstract

Purpose

Herniorrhaphy is a source of substantial cost and morbidity. Although women are a substantial proportion of patients seeking repair, gender-specific data, including the influence of childbirth on hernia recurrence, are lacking. Our objective was to estimate the rate and identify risk factors for repeat herniorrhaphy in reproductive-aged women.

Methods

Retrospective cohort study of women who underwent herniorrhaphy during June 2000–December 2014 in the United States. Women aged 18–50 who underwent umbilical, incisional/ventral, or inguinal/femoral herniorrhaphy in the Truven Health Analytics MarketScan® Commercial Claims and Encounters database were included. Women without a hernia diagnosis or multiple/concurrent index herniorrhaphy types were excluded. Primary outcome of interest was second herniorrhaphy.

Results

Of 123,674 women, 13% had a second herniorrhaphy within 10 years; increasing age, comorbidities, childbirth, smoking, obesity, and inpatient procedure were independently associated with increased risk. Cesarean delivery before umbilical herniorrhaphy (HR 1.61, 95% CI 1.34, 1.92) and both vaginal (HR 2.57, 95% CI 1.98, 3.34) and cesarean delivery (HR 2.95, 95% CI 2.25, 3.87) after umbilical herniorrhaphy were associated with increased risk of second herniorrhaphy. Both vaginal (HR 1.66, 95% CI 1.13, 2.43) and cesarean delivery (HR 2.72, 95% CI 2.09, 3.53) after incisional/ventral herniorrhaphy and vaginal delivery after inguinal/femoral herniorrhaphy (HR 1.75, 95% CI 1.22, 2.51) were associated with increased risk of second herniorrhaphy.

Conclusions

Among reproductive-aged women, childbirth, increasing age, comorbidities, smoking, and obesity increase risk of subsequent herniorrhaphy. Risk of second herniorrhaphy is higher with cesarean delivery compared to vaginal delivery, and higher for delivery occurring after initial hernia repair compared to before.

Keywords

Hernia in women Childbearing Reproductive-age Hernia incidence Herniorrhaphy rate Risk factors for hernia 

Notes

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest to report.

Ethical approval

Institutional Review Board approval was obtained by the University of North Carolina.

Human and animal rights

No procedures were performed on human subjects. All data analyzed in this study was part of a deidentified database.

Informed consent

Informed consent was not indicated as this study involved only the analysis of previously collected and deidentified data and did not involve recruitment of any participants.

Supplementary material

10029_2019_2077_MOESM1_ESM.docx (24 kb)
Supplementary file1 (DOCX 24 kb)

References

  1. 1.
    Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362(9395):1561–1571CrossRefGoogle Scholar
  2. 2.
    Bendavid R, Abrahamson J, Arregui ME, Flament JB, Phillips EH (eds) (2001) Abdominal wall hernias: principles and management. Springer, New York, pp 613–619CrossRefGoogle Scholar
  3. 3.
    Malangoni MA, Hernias RMJ, Jr CM, Beauchamp RD, Evers BM, Mattox KL (eds) (2004) Sabiston textbook of surgery: the biological basis of modern surgical practice, 18th edn. Townsend Elsevier Saunders, Philadelphia, pp 1114–1140Google Scholar
  4. 4.
    Oma E, Henriksen NA, Jensen KK (2018) Ventral hernia and pregnancy: a systematic review. Am J Surg 217:163–168CrossRefGoogle Scholar
  5. 5.
    Novitsky YW (ed) (2016) Hernia surgery: current principles. Springer, Switzerland, pp 15–23Google Scholar
  6. 6.
    Poulose BK, Shelton J, Phillips S et al (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183CrossRefGoogle Scholar
  7. 7.
    Oma E, Jensen KK, Jorgensen LN (2016) Recurrent umbilical or epigastric hernia during and after pregnancy: a nationwide cohort study. Surgery 159(6):1677–1683CrossRefGoogle Scholar
  8. 8.
    Lappen JR, Sheyn D, Hackney DN (2016) Does pregnancy increase the risk of abdominal hernia recurrence after pre-pregnancy surgical repair? Am J Obstet Gynecol 215(3):390.e1–5CrossRefGoogle Scholar
  9. 9.
    Jensen KK, Henriksen NA, Jorgensen LN (2015) Abdominal wall hernia and pregnancy: a systematic review. Hernia 19(5):689–696CrossRefGoogle Scholar
  10. 10.
    Earle DB, McLellan JA (2013) Repair of umbilical and epigastric hernias. Surg Clin N Am 93(5):1057–1089CrossRefGoogle Scholar
  11. 11.
    Claims and Encounters Medicare Supplemental Source (2015) Truven Health MarketScan Research Databases. Data Year 2015 Edition. Truven Health Analytics, Ann ArborGoogle Scholar
  12. 12.
    Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619CrossRefGoogle Scholar
  13. 13.
    Olasehinde O, Etonyeaku AC, Agbakwuru EA et al (2016) Pattern of abdominal wall herniae in females: a retrospective analysis. Afr Health Sci. 16(1):250–254CrossRefGoogle Scholar
  14. 14.
    Aabakke AJ, Krebs L, Ladelund S, Secher NJ (2014) Incidence of incisional hernia after cesarean delivery: a register-based cohort study. PLoS ONE 9(9):e108829CrossRefGoogle Scholar
  15. 15.
    Shand AW, Chen JS, Schnitzler M, Roberts CL (2015) Incisional hernia repair after caesarean section: a population-based study. Aust N Z J Obstet Gynaecol. 55(2):170–175CrossRefGoogle Scholar
  16. 16.
    Oma E, Bay-Nielsen M, Jensen KK et al (2017) Primary ventral or groin hernia in pregnancy: a cohort study of 20,714 women. Hernia 21(3):335–339CrossRefGoogle Scholar
  17. 17.
    Burcharth J, Pommergaard HC, Bisgaard T, Rosenberg J (2015) Patient-related risk factors for recurrence after inguinal hernia repair: a systematic review and meta-analysis of observational studies. Surg Innov 22(3):303–317CrossRefGoogle Scholar
  18. 18.
    Hesselink VJ, Luijendijk RW, de Wilt JH, Heide R, Jeekel J (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176(3):228–234PubMedGoogle Scholar
  19. 19.
    Anthony T, Bergen PC, Kim LT et al (2000) Factors affecting recurrence following incisional herniorrhaphy. World J Surg 24(1):95–100CrossRefGoogle Scholar
  20. 20.
    Hellspong G, Gunnarsson U, Dahlstrand U, Sandblom G (2017) Diabetes as a risk factor in patients undergoing groin hernia surgery. Langenbecks Arch Surg. 402(2):219–225CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyUniversity of North Carolina School of MedicineChapel HillUSA
  2. 2.Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of SurgeryUniversity of North Carolina School of MedicineChapel HillUSA
  4. 4.Department of Obstetrics and GynecologyWake Forest UniversityWake ForestUSA

Personalised recommendations