Approach to Inguinal Hernia Repairs: A Retrospective National Cohort Study in the Republic of Ireland

There is limited data surrounding inguinal hernias repairs (IHR) and associated outcomes in the Republic of Ireland. Minimally invasive approaches offer shorter recovery times and lower risk of chronic pain at the expense of steeper learning curves which may limit widespread adoption. This study aims to qualify the current landscape in IHR in the Republic of Ireland (ROI), and to examine peri-operative outcomes.

All IHRs performed in the ROI between January 2017 and September 2024 were identified retrospectively from the National Quality Assurance and Improvement System (NQAIS) database. Anonymized patient characteristics and quality indices were extracted for analysis.

A total of 20,845 IHR, 72% open an 28% laparoscopic, were performed across 39 public hospitals. Patients undergoing open IHR were significantly older (3.89, p < 0.001), had a significantly longer length of stay (LOS) (0.227, p < 0.001) and were more likely to be readmitted within 7 (χ² [1, N = 20,845] = 4.24, p = 0.039) and 30 days (χ² [1, N = 20,845] = 4.08, p = 0.043). LOS in low volume centers was significantly longer than high volume centers (0.361, p < 0.001). Patients in high volume centers were less likely to have an emergency admission in 1 year (χ² [1, N = 20,845] = 114, p < 0.001). Regression analysis demonstrated that older patients (Estimate 0.0127, OR 1.013, p < 0.001), emergency repairs (Estimate 0.5615, OR 1.753, p < 0.001) and higher ASA grades (Estimate 0.4672, OR 1.596, p < 0.001) to be independently associated with having an open as opposed to laparoscopic IHR.

Despite advances in laparoscopy, open IHR remain the predominant treatment approach in the ROI. Older, more co-morbid patients and those undergoing emergency repairs are far more likely to have an open IHR.