Epidemiological trends and modifiable risk factors for abdominal wall hernias in Saudi Arabia: A retrospective analysis of national hospital discharge data (2016–2023)
Ahmed A. AlmohammadiAbstract
BACKGROUND:
Abdominal wall hernias represent a significant and growing surgical burden globally. Modifiable risk factors including obesity, type 2 diabetes mellitus, smoking, and chronic respiratory disease offer meaningful targets for prevention-oriented interventions. Population-level epidemiological analyses characterizing hernia burden and associated risk factors in Saudi Arabia remain absent from the literature.
OBJECTIVES:
This study aims to characterize the temporal trends in abdominal wall hernia repair procedures, describe the prevalence and distribution of modifiable risk factors among hernia patients, and assess geographic and urban–rural variations in hernia burden and surgical outcomes across Saudi Arabia.
METHODS:
This cross-sectional descriptive study analyzed secondary data from the Saudi Ministry of Health Annual Statistical Yearbooks (2016–2023), the Saudi Health Interview Survey 2018, and World Health Organization (WHO) Global Burden of Disease estimates. Hernia repair procedures were categorized by the type, surgical approach, and administrative region. Modifiable risk factors were analyzed among hernia patients compared to the general adult population. Descriptive statistics and comparative analyses were performed. Reporting followed Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
RESULTS:
Annual hernia repair procedures increased from 38,200 in 2016 to 45,500 in 2023 (rate: 107–130 per 100,000 population), representing a 19.1% increase. Inguinal hernias constituted 67.9% of all repairs, followed by incisional/ventral hernias (19.1%) and umbilical hernias (9.0%). The male-to-female ratio for inguinal hernia was 7.8:1. The obesity prevalence among hernia patients (41.3%) significantly exceeded that among the general adult population (34.2%). Type 2 diabetes mellitus (28.4% vs. 17.8%), current smoking (19.2% vs. 13.1%), and chronic obstructive pulmonary disease (13.7% vs. 7.9%) were all significantly more prevalent in hernia patients. Laparoscopic repair increased from 27.8% to 52.4% for inguinal hernia over the study period, with substantially lower surgical site infection rates compared to open repair (1.4% vs. 3.8%). Northern border regions demonstrated the lowest procedure rates and highest complication rates nationally.
CONCLUSIONS:
Abdominal wall hernia repair procedures are increasing in Saudi Arabia alongside the rising prevalence of modifiable risk factors, particularly obesity and type 2 diabetes mellitus. Preventive strategies targeting obesity reduction, glycemic optimization, and smoking cessation, combined with equitable expansion of laparoscopic repair capacity, represent priority interventions to reduce hernia burden and surgical complications.