Racial Disparities in Emergent Versus Elective Inguinal Hernia Repair

Racial disparities are known to affect surgical outcomes across all subspecialties of surgery, which are especially relevant for conditions such as inguinal hernia where delays in care may necessitate an emergency rather than an elective repair. Elective inguinal hernia repair (IHR) has been shown to have better outcomes compared to emergent IHR. This study aims to examine outcomes of IHR among racial groups.

Adult patients who underwent IHR were analyzed using logistic and binomial regression models. The primary outcome was odds of emergency versus elective surgical repair among different races. The secondary outcomes were the 30 d of postoperative outcomes for the different groups analyzed. We utilized univariable and multivariable logistic regression models and negative binomial regression for primary and secondary outcomes which were adjusted for patient demographic and comorbidities.

Among 289,770 patients, 11,742 (4.05%) patients underwent emergency repairs. Emergency surgery occurs more often in Black patients (odds ratio [OR] 1.75, P < 0.01). Emergency repair itself was independently associated with substantially higher 30-d mortality (OR 8.29, P < 0.01) compared to elective repair. Within the emergency cohort, American Indian or Alaska Native patients had the highest odds of return to OR (OR 3.19, P < 0.01) and surgical site infections (OR 2.50, P = 0.03) compared to other races.

Black patients were almost twice as likely to undergo emergent IHR, though their outcomes are comparable to White patients. The outcomes following emergency and elective IHR differed across racial groups.