Sex, race, and socioeconomic distinctions in incisional hernia management

Background: We sought to explore the impact of sex, race, and insurance status on operative management of incisional hernias. Methods: A retrospective cohort study was conducted to explore adult patients diagnosed with an incisional hernia. Adjusted odds for non-operative versus operative management and time to repair were queried. Results: Of the 29,475 patients with an incisional hernia, 20,767 (70.5%) underwent non-operative management. In relation to private insurance, Medicaid (aOR 1.40, 95% CI 1.27–1.54), Medicare (aOR 1.53, 95% CI 1.42–1.65), and uninsured status (aOR 1.99, 95% CI 1.71–2.36) were independently associated with non-operative management. African American race (aOR 1.30, 95% CI 1.17–1.47) was associated with non-operative management while female sex (aOR 0.81, 95% CI 0.77–0.86) was predictive of elective repair. For patients who underwent elective repair, both Medicare (aOR 1.40, 95% CI 1.18–1.66) and Medicaid (aOR 1.49, 95% CI 1.29–1.71) insurance, but not race, were predictive of delayed repair (>90 days after diagnosis). Conclusions: Sex, race, and insurance status influence incisional hernia management. Development of evidence-based management guidelines may help to ensure equitable care.