# Evolving Inguinal Hernia Repair Practice at the Veterans Health Administration

## TL;DR

This study tracks how inguinal hernia repair procedures and techniques have changed among US veterans over 20 years, showing increased use of minimally invasive surgery.

## Contribution

The study provides the first comprehensive analysis of inguinal hernia repair trends in the Veterans Health Administration over two decades.

## Key findings

- Inguinal hernia repair volume increased by nearly 50% from 2002 to 2022 in the VHA.
- Minimally invasive surgery use rose from 9% to 41% during the study period.
- Female veterans had higher rates of minimally invasive surgery and urgent repairs compared to male veterans.

## Abstract

This cohort study examines 20 years of data for US veterans who had inguinal hernia repair to track trends and changes in volume and surgical approach.

How have volume and surgical approach to inguinal hernia repair (IHR) in veterans changed within the Veterans Health Administration (VHA) over the last 20 years?

This cohort study involving 308 876 veterans (2002 to 2022) found that IHR volume increased nearly 50%, with minimally invasive approaches increasing from 9% to 41%. Community-based procedures were more often urgent/emergent, and female veterans had higher rates of minimally invasive surgery and urgent repairs.

These results highlight significant growth in IHR volume and a shift toward minimally invasive approaches in the VHA, illustrating evolving technical practice and veterans’ surgical needs, providing data to inform policy and resource allocation.

Inguinal hernia repair (IHR) is one of the most commonly performed operations in the United States, with approximately 800 000 performed each year. US veterans are a unique group that is predominantly male and tends to have higher rates of medical comorbidities and tobacco use, common risk factors for hernia development. With significant advancements in IHR technique in recent years, the majority of national database studies have focused on civilian populations.

To examine trends and the evolution of IHR within the Veterans Health Administration (VHA) over the past 20 years.

This cohort study examined national data retrospectively from all VHA institutions in the period 2002 to 2022. Participants were veterans who received IHR within the VHA were identified through the Corporate Data Warehouse using procedure and diagnosis codes. Data were analyzed from January to April 2025.

Inguinal hernia repair.

Surgical volumes and trends in IHR surgical approach across the VHA were examined over time. Additional measures included procedural urgency and surgical setting.

A total of 308 876 veterans underwent IHR from 2002 to 2022. Patients were predominantly male (306 905 [99.4%]; 1971 female patients [0.6%]), with a median (IQR) age of 65 (57-73) years. They had high rates of hypertension (198 792 [64.4%]), depression (102 880 [33.3%]), chronic obstructive pulmonary disease (82 608 [26.7%]) and alcohol use disorder (68 427 [22.2%]). A total of 60 088 patients (19.5%) underwent minimally invasive (MIS) IHR while 246 403 procedures (79.8%) were open. Most were outpatient (300 400 [97.3%]); only 17 352 (5.6%) were urgent or emergent. Compared with men, women were more likely to undergo MIS-IHR (452 women [22.9%] vs 59 636 men [19.4%]) and urgent/emergent procedures (218 women [11.1%] vs 17 134 men [5.6%]). Annual IHR volume increased from 12 086 in 2002 to 17 897 in 2022, with an increase in MIS-IHR from 1102 (9.2%) to 7286 (41.0%). After a decline during COVID-19, IHR numbers have since recovered and surpassed pre-2020 volume. Throughout the study period, IHRs performed in the community were more likely to be urgent or emergent cases (1015 [28.1%] vs 16 337 [5.4%] in Veterans Affairs [VA] facilities).

This study found that over the past 20 years, the volume of IHRs performed in the VHA system has increased, along with MIS approaches. Hernia repairs are a significant surgical burden within the veteran population, reflecting the evolving surgical practices and needs of this unique demographic.