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Risk factors for complications in Groin Hernia surgery: A National register study
Östersunds Hosp, Dept Surg, S-83183 Östersund, Sweden.
Karolinska Inst, Huddinge Univ Hosp, Dept Surg, Stockholm, Sweden.
Helsingborg Hosp, Dept Surg, Helsingborg, Sweden.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. (Östersunds Hosp, Dept Surg, S-83183 Östersund, Sweden)
2012 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 255, no 4, 784-788 p.Article in journal (Refereed) Published
Abstract [en]

Objective: This study aims to analyze and identify risk factors for postoperative complications and analyze the relative risk of reoperation for recurrence for respective complication. Background: The outcome of groin hernia surgery is evaluated mostly by comparing recurrence rates and long-term pain. The aim of this observational population-based registry study was to identify risk factors for postoperative complications and analyze the relative risk of reoperation for recurrence for respective complication. Methods: Using data from the nationwide Swedish Hernia Register between 1998 and 2009, 150,514 herniorrhaphies were analyzed with respect to postoperative complications occurring within 30 days of surgery. Results: Risk factors significantly affecting the rate of postoperative complications were laparoscopic repair (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.24-1.47) and open preperitoneal techniques (OR: 1.31, 95% CI: 1.15-1.49), with open anterior mesh as reference category. Other significant risk factors were general (OR: 1.30, 95% CI: 1.23-1.37) and regional anesthesia (OR: 1.53, 95% CI: 1.43-1.63), with local anesthesia as reference category, emergency procedures (OR: 1.53, 95% CI: 1.43-1.63); recurrent hernia repair (OR: 1.39, 95% CI: 1.27-1.52); femoral hernia (OR: 1.30, 95% CI: 1.14-1.48); aged older than 65 years (OR: 1.26, 95% CI: 1.21-1.31); and duration of surgery exceeding 50 minutes (OR: 1.27, 95% CI: 1.22-1.33). Conclusions: Open anterior approach and surgery under local anesthesia are associated with less risk of postoperative complications.

Place, publisher, year, edition, pages
Philasdelphia, PA, USA: Lippincott Williams & Wilkins, 2012. Vol. 255, no 4, 784-788 p.
Keyword [en]
Inguinal-Hernia, Open repair, Follow-up, Open mesh, Randomized-trial, Lichtenstein, Reoperation, Recurrence, Anesthesia, Pain
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-54315DOI: 10.1097/SLA.0b013e31824b7cb3ISI: 000301742500025OAI: oai:DiVA.org:umu-54315DiVA: diva2:523449
Available from: 2012-04-24 Created: 2012-04-24 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Outcomes and complications in surgical and urological procedures
Open this publication in new window or tab >>Outcomes and complications in surgical and urological procedures
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background:

Minor procedures in surgery and urology such as groin hernia and hydrocele repair, as well as prostate biopsies are very frequently done in routine practice. Complications and insufficient outcomes thus affecting many patients and the cumulative effect of this are of major importance in a population perspective.

Aim:

To explore complications and outcomes of surgical or diagnostic procedures and possible risk factors or predictors for adverse effects. Methods: By using both national quality and administrative registers, and by complementing registers with patient reported outcome measures, examine outcomes such as complications, persistent pain and recurrences. Also, in the case of hydro and spermatoceles, report incidence numbers. Further, by using a randomized trial, explore minimally invasive procedure such as sclerotheraphy compared to conventional surgery in respect to cure and adverse events.

Results:

When comparing with the open anterior mesh repair, endoscopic technique is advantageous in respect to the patient reported outcome of persistent pain. The drawback was an increased risk of postoperative complications and reoperation for recurrence. Incidence numbers for hydro and spematocele were 100/100000 men. Aspiration (± sclerotherapy) had a significantly lower rate of complications as compared to conventional surgery. In the interim analysis of the randomized trial, comparing sclerotherapy to Lord´s procedure for hydroceles, the cure rate was similar between treatments. Definite conclusions cannot be made due to the risk of type 2 errors, and the study will thus continue. In the case of trans-rectal prostate biopsy, the rates increased every year during the study time frame, up to an approximate risk of two per cent in 2012 for hospital readmission within 30 days, without an increased mortality within 30 days.

Conclusions:

The open anterior mesh procedure is still the preferred method for groin hernia repair in routine surgical practice. Hydro and spermatocele surgery is associated with high rates of complications, and the indication for repair should be scrutinized. The rates of infection after prostate biopsy is increasing and methods to reduce unnecessary biopsies as well as improved prophylaxis should be investigated.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2017. 66 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1899
Keyword
Hydrocele, Spermatocele, Groin hernia, prostate biopsy, complication, infection, chronic pain
National Category
Urology and Nephrology
Research subject
Urology; Surgery
Identifiers
urn:nbn:se:umu:diva-135046 (URN)978-91-7601-717-3 (ISBN)
Public defence
2017-06-09, Hörsalen, Östersunds sjukhus, Östersund, 09:00 (English)
Opponent
Supervisors
Available from: 2017-05-19 Created: 2017-05-17 Last updated: 2017-05-24Bibliographically approved

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