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Predictive model for contralateral inguinal hernia repair within three years of primary repair: a nationwide
Hung-Yu Lin1,2, Chung-Yen Chen3,4,2, Jian-Han Chen5,6,7
1Division of Urology, Department of Surgery, E-Da Cancer and E-Da Hospital, Kaohsiung, Taiwan.
Insights
A new scoring system can predict the risk of contralateral inguinal hernia (CIH) repair within three years after primary unilateral inguinal hernia repair. This tool helps surgeons optimize surgical approach and minimize future interventions.
Area of Science:
- Urology
- General Surgery
Background:
- Limited research exists on risk factors for contralateral inguinal hernia (CIH) repair.
- A novel scoring system was developed to predict CIH within three years post-unilateral inguinal hernia repair.
Purpose of the Study:
- To develop and validate a risk factor scoring system for predicting contralateral inguinal hernia (CIH) repair after primary unilateral inguinal hernia repair.
- To aid surgeons in surgical decision-making and potentially reduce the need for future interventions.
Main Methods:
- Retrospective analysis of 170,492 adult male patients undergoing primary unilateral inguinal hernia repair from the National Health Insurance Research Database.
- Development of a logistic regression-based scoring system incorporating age and comorbidities (cirrhosis, prostate disease).
- Validation of the scoring system using an 80/20 train/test split, assessing predictive accuracy via ROC curves.
Main Results:
- The scoring system, ranging from 0-5 points, demonstrated predictive capability in both derivation (AUC=0.606) and validation (AUC=0.551) cohorts.
- Higher scores correlated with increased risk of CIH repair; for instance, a score of 5 indicated a 6.9% risk in the derivation group.
- The system identified patients with a higher likelihood of CIH, with adjusted odds ratios (OR) for CIH repair increasing with higher scores.
Conclusions:
- The developed CIH scoring system effectively predicts the need for contralateral inguinal hernia repair within three years.
- Scores greater than 2 suggest potential benefit from laparoscopic surgery for simultaneous contralateral exploration and repair, minimizing future surgeries.
- Prospective validation is recommended to further confirm the clinical utility of this CIH scoring system.
Background:
Limited reports have discussed the risk factors for contralateral inguinal hernia (CIH) repair. We generated a risk factor scoring system to predict CIH within 3 years after unilateral inguinal hernia repair.
Methods:
We extracted the admission data of patients aged ≥ 18 years who underwent primary unilateral inguinal hernia repair without any other operation from the National Health Insurance Research Database. Patients were randomly divided into 80% and 20% validation cohorts. Multivariate analysis with a logistic regression model was used to generate the scoring system, which was used in the validation group.
Results:
Overall, 170,492 adult men were included, with a median follow-up of 87 months. The scoring system ranged from 0-5 points, composited with age (< 45 years, 0 points; 45-65 years, 2 points; 65-80 years, 3 points; > 80 years, 2 points) and two comorbidities (cirrhosis and prostate disease: 1 point each). The areas under receiver operating characteristic (ROC) curves were 0.606 and 0.551 for the derivation and validation groups, respectively. The rates and adjusted odds ratios (OR) of CIH repair in the derivation group were 3.0% at 0-2 points, 5.5% (1.854, p < 0.001) at 3, 6.7% (2.279, p < 0.001) at 4, and 6.9% (2.348, p < 0.001) at 5, with similar results in the validation group [2.3% at 0-2 points, 3.8% (1.668, p < 0.001) at 3, 5.4% (2.386, p < 0.001) at 4, and 6.8% (3.033, p < 0.001) at 5].
Conclusions:
The CIH scoring system effectively predicted CIH repair within three years of primary unilateral inguinal hernia repair. Surgeons could perform laparoscopic surgery with CIH scores > 2 points which enables easier contralateral exploration and repair during the same surgery, without additional incisions, to minimize the need for future surgeries. However, further prospective validation of this scoring system is required.
