Sex, race, and socioeconomic distinctions in incisional hernia management

We sought to explore the impact of sex, race, and insurance status on operative management of incisional hernias. 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. 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). Sex, race, and insurance status influence incisional hernia management. Development of evidence-based management guidelines may help to ensure equitable care. •Incisional hernia management may be biased by patient and provider factors.•Black patients are less likely to have surgical repair of incisional hernias.•Public insurance is associated with delayed incisional hernia repair.