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Risk factors for repeat hernia repair in women of childbearing age

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



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.


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.


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.


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.


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



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)


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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

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