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Mortality after groin hernia surgery: delay of treatment and cause of death
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.
2011 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, no 3, 301-307 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Emergency hernia surgery, in contrast to elective hernia surgery, is associated with appreciable mortality. Incarcerated hernia is the second most common cause of small bowel obstruction after adhesions, and the leading cause of bowel strangulation.

METHODS: Information on patients who died within 30 days of groin hernia surgery was retrieved from the Swedish Hernia Register, from the Cause-of-Death Register, and from hospital notes.

RESULTS: Of 103,710 groin hernia operations between 1992 and 2004, 292 patients died within 30 days of surgery. Hospital notes and cause of death were retrieved for 242 cases (82%). In 5 of these patients, the hernia operation was done in addition to more urgent surgery and therefore excluded from further analyses; 152 patients were admitted as emergency cases and 55 of these patients underwent bowel resection. A total of 107 patients had signs of bowel obstruction when admitted. For 37% of these patients, physical examination of the groin was not documented. Patients with bowel obstruction without a note on a palpable groin lump were more likely to undergo imaging investigation preoperatively (P < 0.001) and they had an increased time to surgery compared to patients with a palpable lump. Women and patients with femoral hernia were significantly less likely to undergo a groin examination compared to other patients. Local anaesthesia was used in 7% of all patients who died postoperatively, and in 3% of emergency cases. Pulmonary disease, sepsis and malignant disease were more common as causes of death after emergency surgery than after elective surgery.

CONCLUSIONS: Groin examination of patients presenting with bowel obstruction is of utmost importance in order to minimise delay to hernia surgery.

Place, publisher, year, edition, pages
Paris: Springer, 2011. Vol. 15, no 3, 301-307 p.
Keyword [en]
Groin hernia, Inguinal hernia, Femoral hernia, Mortality, Bowel obstruction
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-57293DOI: 10.1007/s10029-011-0782-4PubMedID: 21267615OAI: oai:DiVA.org:umu-57293DiVA: diva2:540746
Available from: 2012-07-11 Created: 2012-07-11 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)
Opponent
Supervisors
Available from: 2013-11-19 Created: 2013-11-14 Last updated: 2013-11-19Bibliographically approved

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