Demographics, diagnostics, treatment, and outcomes of patients presenting with acute groin hernia: 15-year multicentre retrospective cohort study

• Published in: BJS open Vol. 7; no. 5
• Main Authors: Brown, Leo R, Clyde, Danielle R, Li, Lucy Q, Swan, Rebecca, McLean, Ross C, Damaskos, Dimitrios
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 05.09.2023
• Subjects: Aged; Aged, 80 and over; Demography; Female; Groin; Hernia, Femoral - epidemiology; Hernia, Femoral - surgery; Hernia, Inguinal - diagnosis; Hernia, Inguinal - epidemiology; Hernia, Inguinal - surgery; Humans; Male; Middle Aged; Original; Retrospective Studies; State Medicine
• ISSN: 2474-9842; 2474-9842
• DOI: 10.1093/bjsopen/zrad091

Abstract Background Groin hernias commonly present acutely in high-risk populations and can be challenging to manage. This retrospective, observational study aimed to report on patient demographics and outcomes, following acute admissions with a groin hernia, in relation to contemporary investigative and management practices. Methods Adult (≥18 years old) patients who presented acutely with a groin hernia to nine National Health Service trusts in the north of England between 2002 and 2016 were included. Data were collected regarding patient demographics, radiological investigations, and operative intervention. The primary outcome of interest was 30-day inpatient mortality rate. Results Overall, 6165 patients with acute groin hernia were included (4698 inguinal and 1467 femoral hernias). There was a male preponderance (72.5 per cent) with median age of 73 years (interquartile range (i.q.r.) 58–82). The burden of patient co-morbidity increased over the study period (P < 0.001). Operative repair was performed in 2258 (55.1 per cent) of patients with an inguinal and 1321 (90.1 per cent) of patients with a femoral hernia. Bowel resection was more commonly required for femoral hernias (14.7 per cent) than inguinal hernias (3.5 per cent, P < 0.001) and in obstructed (14.6 versus 0.2 per cent, P < 0.001) or strangulated (58.4 versus 4.5 per cent, P < 0.001) hernias. The 30-day mortality rate was 3.1 per cent for the overall cohort and 3.9 per cent for those who underwent surgery. Bowel resection was associated with increased duration of hospital stay (P < 0.001) and 30-day inpatient mortality rate (P < 0.001). Following adjustment for confounding variables, advanced age, co-morbidity, obstruction, and strangulation were all associated with an increased 30-day mortality rate (all P < 0.001). Conclusion Emergency hernia repair has high mortality rates. Advanced age and co-morbidity increase both duration of hospital stay and 30-day mortality rate. Acute groin hernia presentations are a common feature of the emergency general surgery workload. This high-volume, retrospective, observational study shows that patients presenting with groin hernias are often elderly and are becoming increasingly co-morbid. Changing patient demographics are influencing investigation and management techniques as demonstrated in this study.