Hernia surgery in a defined population: a prospective three year audit

Area of Science:

• Surgical Audit
• Hernia Repair Outcomes
• Quality Improvement in Surgery

Background:

• Inguinal hernia repair is a common surgical procedure.
• Variations in surgical outcomes and reoperation rates for inguinal hernias exist across different healthcare centers.
• Establishing a standardized data collection system is crucial for analyzing and improving surgical quality.

Purpose of the Study:

• To create a multi-center registry for inguinal hernia surgery in Sweden.
• To enable auditing and analysis of surgical data to identify variations in outcomes.
• To investigate factors influencing reoperation rates after inguinal hernia repair.

Main Methods:

• Prospective data collection using a common protocol across eight Swedish hospitals.
• Inclusion of all inguinal hernia operations for patients over 15 years old from January 1992 to December 1994.
• Tracking methods of repair, postoperative complications, mortality, day surgery rates, and reoperations for recurrence.

Main Results:

• 4879 hernia operations were performed on 4474 patients over three years.
• 30-day postoperative mortality was 3.5% for emergency and 0.07% for elective repairs.
• 4% of all operations required reoperation due to recurrence within 24 months, with significant inter-hospital variations (1.5%–6.7%).
• Postoperative complications, direct hernias, recurrent hernias, and absorbable sutures were linked to increased reoperation risk.

Conclusions:

• A voluntarily maintained quality register can reveal significant inter-hospital outcome disparities.
• The registry identified variables associated with a higher risk of reoperation.
• This data facilitates quality awareness and drives improvement processes in inguinal hernia surgery.