Impact of anxiety and depression on patient reported outcomes following inguinal and ventral hernia repair.

PURPOSE: Anxiety and depression are common among surgical patients and may influence both subjective and objective postoperative outcomes. This study aimed to evaluate the association between preoperative anxiety or depression and clinical and patient-reported outcomes (PROs) following ventral and inguinal hernia repairs. METHODS: This retrospective cohort study utilized data from the Abdominal Core Health Quality Collaborative (ACHQC) from 2012 to 2024. Adult patients undergoing ventral or inguinal hernia repair were included. Patients with a diagnosis of anxiety or depression were propensity score-matched 1:1 to controls without these diagnoses, based on demographic and clinical characteristics. Outcomes analyzed included surgical complications (SSI, SSO, SSOPI, readmission, reoperation, recurrence) and PROs (HerQLes, PROMIS, and EuraHS), assessed at baseline and 30 days postoperatively. After propensity matching, patients with anxiety/depression had worse baseline PROs, yet the improvement from baseline to 30 days was similar to controls across instruments. Post-match analyses emphasized change from baseline and clinical relevance; statistical tests were two-sided and de-emphasized in interpretation. RESULTS: Among 48,693 patients (30,315 ventral, 18,378 inguinal), 1,875 (6.2%) and 1,008 (5.5%), respectively, had a diagnosis of anxiety or depression. After matching, 3,170 ventral and 1,768 inguinal hernia patients were analyzed. In both cohorts, patients with psychiatric comorbidities reported significantly worse PROs at baseline and 30 days. HerQLes and PROMIS scores (ventral) and EuraHS scores for pain, restriction, and overall quality of life (inguinal) were significantly worse in the anxiety/depression group. No differences in postoperative complications were observed after matching. CONCLUSION: Patients with preoperative anxiety or depression start with worse baseline quality of life but achieve a similar degree of improvement after inguinal or ventral hernia repair as matched controls; residual postoperative differences are small and below conventional MCID thresholds, but they remain relevant for perioperative counseling and expectation management. These conditions should inform PROs interpretation and perioperative support, not deter repair.