Trends in Emergent Groin Hernia Repair-An Analysis From the Herniamed Registry

Abstract

Introduction: While the proportion of emergency groin hernia repairs in developed countries is 2.5-7.7%, the percentage in developing countries can be as high as 76.9%. The mortality rate for emergency groin hernia repair in developed countries is 1.7-7.0% and can rise to 6-25% if bowel resection is needed. In this present analysis of data from the Herniamed Registry, patients with emergency admission and operation within 24 h are analyzed. Methods: Between 2010 and 2019 a total of 13,028 patients with emergency admission and groin hernia repairs within 24 h were enrolled in the Herniamed Registry. The outcome results were assigned to the year of repair and summarized as curves. The total patient collective is broken down into the subgroups with pre-operative manual reduction (taxis) of the hernia content, operative reduction of the hernia content without bowel resection and with bowel resection. The explorative Fisher's exact test was used for statistical assessment of significant differences with Bonferroni adjustment for multiple testing. Results: The proportion of emergency admissions with groin hernia repair within 24 h was 2.7%. The percentage of women across the years was consistently 33%. The part of femoral hernias was 16%. The proportion of patients with pre-operative reduction (taxis) remained unchanged at around 21% and the share needing bowel resection was around 10%. The proportion of TAPP repairs rose from 21.9% in 2013 to 38.0% in 2019 (p < 0.001). Between the three groups with pre-operative taxis, without bowel resection and with bowel resection, highly significant differences were identified between the patients with regard to the rates of post-operative complications (4% vs. 6.5% vs. 22.7%; p < 0.0001), complication-related reoperations (1.9% vs. 3.8% vs. 17.7%; p < 0.0001), and mortality rate (0.3% vs. 0.9% vs. 7.5%; p < 0.001). In addition to emergency groin hernia repair subgroups female gender and age ≥66 years are unfavorable influencing factors for perioperative outcomes. Conclusion: For patients with emergency groin hernia repair the need for surgical reduction or bowel resection, female gender and age ≥66 years have a highly significantly unfavorable influence on the perioperative outcomes.

Keywords: bowel resection; emergency; groin hernia; mortality; perioperative complications.

Figure 1

Flowchart of patient inclusion.

Figure 2

Gender of emergency groin hernia repair patients (n = 13,028) (2010–2019). *Bonferroni-adjusted (factor 2) for multiple testing.

Figure 3

Defect localization in emergency groin hernia repairs using EHS classification (n = 13,717 procedures) (2010–2019). *Bonferroni-adjusted (factor 5) for multiple testing.

Figure 4

Defect size in emergency groin hernia repairs using EHS classification (n = 13,717 procedures) (2010–2019). *Bonferroni-adjusted (factor 3) for multiple testing.

Figure 5

Emergency groin hernia repairs (n = 13,028 patients/n = 13,717 procedures) in different techniques (2010–2019). *Bonferroni-adjusted (factor 5) for multiple testing.

Figure 6

Subgroups of patients with emergency groin hernia repairs (n = 13,028) (2010–2019). *Bonferroni-adjusted (factor 3) for multiple testing.

Figure 7

Emergency groin hernia repairs (n = 2,789) for patients without incarceration/strangulation (taxis, reduction) with different techniques (2010–2019). *Bonferroni-adjusted (factor 5) for multiple testing.

Figure 8

Emergency groin hernia repairs (n = 9,608) for patients with incarceration/strangulation without bowel resection in different techniques (2010–2019). *Bonferroni-adjusted (factor 5) for multiple testing.

Figure 9

Emergency groin hernia repairs (n = 1,320) for patients with incarceration/strangulation and bowel resection with different techniques (2010–2019). *Bonferroni-adjusted (factor 5) for multiple testing.

Figure 10

Post-operative surgical complications of emergency groin hernia repairs in different subgroups (n = 13,717) (2010–2019). *Bonferroni-adjusted (factor 3) for multiple testing.

Figure 11

Complication-related reoperation rate of emergency groin hernia repairs (n = 13,717) in different subgroups (2010–2019). *Bonferroni-adjusted (factor 3) for multiple testing.

Figure 12

General complications in emergency groin hernia patients (n = 13,028) in different subgroups (2010–2019). *Bonferroni-adjusted (factor 3) for multiple testing.

Figure 13

Mortality rate of emergency admissions and groin hernia repairs within 24 h (n = 13,028) in different subgroups (2010–2019) (total n = 188/13,028; 1.44%).

Figure 14

Recurrence rate at 1-year follow-up of emergency groin hernia patients (n = 8,303 follow-up rate: 77.7%) in different subgroups (2010–2018). *Bonferroni-adjusted (factor 3) for multiple testing.

Figure 15

Chronic pain requiring treatment at 1-year follow-up of emergency inguinal hernia patients (n = 8,303 follow-up rate: 77.7%) in different subgroups (2010–2018). *Bonferroni-adjusted (factor 3) for multiple testing.