Hernia surgery in a defined population: a prospective three year audit

Abstract

Objective: To establish a register of inguinal hernia surgery that allows audit and analyses of data from several centres.

Design: Prospective recording of data on a common protocol.

Setting: Eight Swedish hospitals.

Subjects: All groin hernia operations done for patients over 15 years old from January 1992 to December 1994.

Main outcome measures: Methods of repair, postoperative complications including mortality, day surgery rate, and reoperations for recurrence.

Results: During the three years studied 4879 hernia operations were undertaken in 4474 patients. Postoperative mortality within 30 days of operation for emergency and elective hernia repairs was 3.5% and 0.07%, respectively. Of all herniorrhaphies 798 (16%) were done for recurrences, 142 of these after operations between 1992 and 1994. At 24 months 4% of all operations had been redone because of recurrences with highly significant variations among hospitals ranging from 1.5% to 6.7%. Postoperative complications within 30 days after operation, direct hernia, recurrent hernia, and the use of absorbable sutures were associated with an increased risk of reoperation.

Conclusions: A quality register recorded voluntarily can identify significant interhospital differences in outcome as well as variables associated with an increased risk of reoperation, thereby raising quality awareness and facilitating the process of improvement.