Trends of inguinal hernia repairs performed for recurrence in the United States

Abstract

Background: One of the main complications of inguinal hernia repair continues to be recurrence. Commonly cited prior reports from relatively small studies estimate this rate to be 1% to 5% in the United States. Although some reports have found higher recurrence rates, they get little attention on the national stage or in other large studies. We sought to determine the trend of inguinal hernia repairs performed for recurrence over time using large national databases.

Methods: We identified patients aged ≥18 years who underwent inguinal hernia repair from three sources: the Premier database (January 2010 to September 2015), the American College of Surgeons National Surgical Quality Improvement Program database (January 2005 to December 2014), and the Mayo Clinic institutions (January 2005 to December 2014). We evaluated the incidence of primary and recurrent inguinal hernia repairs stratified by sex over time using one-tailed Cochran-Armitage tests.

Results: In the Premier database, of the 317,636 inguinal hernia repairs, the proportion performed for recurrence had a small decrease in males from 11.4% in 2010 to 10.5% in 2015 (P < .0001); however, it remained constant in females (6.5% in 2010 to 6.7% in 2015, P = .46). In the National Surgical Quality Improvement Program database, of the 180,512 inguinal hernia repairs, there was no change for either sex: 10.5% to 11.2% (2005-2014, P = .12) in males and 6.2% to 7.1% (2005-2014, P = .11) in females. Within our institution, in the 9,216 patients identified, there was no change in the proportion of inguinal hernia repairs for recurrence in males: 13.3% to 11.5% (2005-2014, P = .25). In females, the proportion increased from 1.3% to 12.0% during the study period (P = .006).

Conclusion: Based on these larger evaluations of recurrent inguinal hernia surgery, the current literature on inguinal hernia repair recurrence is skewed and overly optimistic.