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Mortality after groin hernia surgery
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Sahlgrenska University Hospitalt, Göteborg, Sweden.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
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2007 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 245, no 4, 656-660 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To analyze mortality following groin hernia operations.

Summary Background Data: It is well known that the incidence of groin hernia in men exceeds the incidence in women by a factor of 10. However, gender differences in mortality following groin hernia surgery have not been explored in detail.

Methods: The study comprises all patients 15 years or older who underwent groin hernia repair between January 1, 1992 and December 31, 2005 at units participating in the Swedish Hernia Register (SHR). Postoperative mortality was defined as standardized mortality ratio (SMR) within 30 days, ie, observed deaths of operated patients over expected deaths considering age and gender of the population in Sweden.

Results: A total of 107,838 groin hernia repairs (103,710 operations), were recorded prospectively. Of 104,911 inguinal hernias, 5280 (5.1%) were treated emergently, as compared with 1068 (36.5%) of 2927 femoral hernias. Femoral hernia operations comprised 1.1% of groin hernia operations on men and 22.4% of operations on women. After femoral hernia operation, the mortality risk was increased 7-fold for both men and women. Mortality risk was not raised above that of the background population for elective groin hernia repair, but it was increased 7-fold after emergency operations and 20-fold if bowel resection was undertaken. Overall SMR was 1.4 (95% confidence interval, 1.2-1.6) for men and 4.2 (95% confidence interval, 3.2-5.4) for women, in accordance with a greater proportion of emergency operations among women compared with men, 17.0%, versus 5.1%.

Conclusions: Mortality risk following elective hernia repair is low, even at high age. An emergency operation for groin hernia carries a substantial mortality risk. After groin hernia repair, women have a higher mortality risk than men due to a greater risk for emergency procedure irrespective of hernia anatomy and a greater proportion of femoral hernia.

Place, publisher, year, edition, pages
2007. Vol. 245, no 4, 656-660 p.
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-5976DOI: 10.1097/01.sla.0000251364.32698.4bPubMedID: 17414617OAI: oai:DiVA.org:umu-5976DiVA: diva2:145644
Available from: 2007-12-04 Created: 2007-12-04 Last updated: 2017-05-29Bibliographically approved
In thesis
1. Mortality and morbidity after groin hernia surgery: the role of nationwide registers in finding and analysing rare outcomes
Open this publication in new window or tab >>Mortality and morbidity after groin hernia surgery: the role of nationwide registers in finding and analysing rare outcomes
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Groin hernia surgery is one of the most common surgical procedures world-wide. Although mainly uncomplicated, the large volume of these operations makes it important to consider severe postoperative complications. The Swedish Hernia Register (SHR) started in 1992 and has grown to include more than 95% of all groin hernia operations performed in Sweden empowering it to be merged with other registers in population-based studies. The aim of this thesis is to merge SHR with other nation-wide registers to analyse postoperative mortality, cardiovascular morbidity, surgical hazards, as well as to study the influence of prostatectomy upon the risk for subsequent groin hernia surgery.

Methods: SHR was interlinked with the Cause of Death Register to find standardised mortality ratio, the National Prostate Cancer Register to find incidence of groin hernia surgery after prostatectomy compared to a control group and with the National Patient Register to find morbidity within 30 days of groin hernia surgery. In paper II, medical records of deceased patients were retrieved and scrutinised.

Results: Elective groin hernia surgery was found to be a low risk procedure even for elderly patients. The mortality risk within 30 days of emergency surgery was raised sevenfold compared to that of the background population. Women had a threefold increased risk of postoperative mortality compared to men. Patients with bowel obstruction, not examined for groin hernia in the emergency room, were subject to more radiological examinations and were operated significantly later than patents with a clinical diagnosis of groin hernia. Compared to men, significantly fewer women were examined for groin hernia in the emergency ward, 61% vs. 78%, (P=0.04). High age, co-morbidity, emergency operation, and regional anaesthesia were risk factors for cardiovascular events. Compared to open anterior mesh repair, all other methods were associated with increased risk of surgical complication, intra-operatively or postoperatively. A threefold increase in groin hernia surgery was seen after radical prostatectomy, conventional as well as minimally invasive.

Discussion: Women are significantly overrepresented concerning mortality after groin hernia surgery. This thesis shows the importance of nation-based registers in the analysis of infrequent phenomena in surgical care.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2013. 54 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1614
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:umu:diva-82975 (URN)978-91-7459-755-4 (ISBN)
Public defence
2013-12-13, Tandläkarhögskolan, sal B, 9 tr, Norrlands universitetssjukhus, Umeå, 13:00 (English)
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Available from: 2013-11-19 Created: 2013-11-14 Last updated: 2013-11-19Bibliographically approved

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