Hydrocelectomy Complication Rates in the United States

Hydrocelectomy is the gold standard treatment for hydrocele. European data showed complication rates between 16% and 25%, however the rate within the United States has not been assessed. We examined the postoperative complication, emergency department visit, readmission and re-operation rates after hydrocelectomy in the United States.

We performed a retrospective cohort study of 27,418 individuals who underwent hydrocelectomy in the United States between 2004 and 2024 identified through the TriNetX US Network using ICD-10 and CPT codes. Patients were excluded for age <18 years, testicular neoplasm, and orchiectomy. The primary outcome was rate of any surgical complication, emergency department (ED) visit, readmission, or reoperation within 90 days of hydrocelectomy. Statistical analysis was performed with R software and using t-tests.

The mean age of our cohort was 51 years. The complication group had higher proportions of older (p < 0.001), African American (p < 0.001), and patients with hypertension, diabetes, and coagulation defects (p < 0.001).The risk of complications was 13% within 90 days of surgery. The ED visit rate was 6.7%, surgical complication rate of 5.6%, readmission rate of 2.6%, and reoperation rate of 2.6%. Of surgical complications, 25% were bleeding, 13% were infection, and 63% were inflammatory or unspecified complications. The median ED visit was day 14 (IQR 6-41) and the median reoperation was at day 21 (IQR 9-38). Patients had a 9.2% rate of overall complications in the first month after surgery, after which the risk decreased.

The rate of complications after hydrocelectomy in the United States is 13%, with 9% occurring in the first 30 days. There was a 2.8% risk of surgical intervention within 90 days. We recommend close follow-up in the first month to evaluate for developing complications, especially for patients with hypertension, diabetes, or coagulation defects.