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Reoperation as surrogate endpoint in hernia surgery. A three year follow-up of 1565 herniorrhaphies
A Kald1, E Nilsson, B Anderberg
1Department of Surgery at the University of Linköping, Sweden.
Objective:
Analysis of reoperation and recurrence rates three years after repair of groin hernias.
Design:
Prospective audit by questionnaire and selective follow-up.
Setting:
Eight Swedish hospitals.
Subjects:
All groin hernia operations done during 1992 on patients between the ages of 15 and 80 years.
Main Outcome Measures:
Postoperative complications, reoperation for recurrence, and recurrence.
Results:
During 1992, 1565 hernia operations were done. The postoperative complication rate was 8% (125/1565). At 36 months postoperatively 108 recurrences had already been reoperated on, six patients with recurrences were on the waiting list for reoperation and a further 36 recurrences had been detected at follow-up. The interhospital variation in recurrence rate ranged from 3% to 20%. Postoperative complications, recurrent hernia, direct hernia and hospital catchment area over 100000 inhabitants were all factors associated with an increased relative risk of recurrence.
Conclusions:
The recurrence rate exceeded the reoperation rate for recurrence by almost 40% which should be taken into account if the reoperation rate is used as the endpoint after repairs of groin hernia. An audit scheme, based on prospective recording, reoperation rate, and (periodic) calculation of the recurrence rate may be used to identify risk factors for recurrence and areas in need of improvement.