Short- and Long-Term Outcomes After Emergency Groin Hernia Surgery: A Nationwide Population-Based Study from the Swedish Hernia Register.

Background/

Objectives: Emergency groin hernia repairs have consistently presented a higher risk of mortality and morbidity. This study aimed to compare both short- and long-term outcomes associated with emergency groin hernia surgery.

Methods: A nationwide, population-based cohort study was conducted using prospective collected data from the Swedish Hernia Register combined with a questionnaire assessing patient-reported chronic pain. All patients who underwent a groin hernia repair between 2012 and 2018 were eligible for inclusion. Primary outcomes included 30-day mortality, chronic pain 1-year post-surgery, 30-day postoperative complication, and bowel resection and reoperation for recurrence for emergency versus elective repairs. Risk factors for these outcomes in emergency repair were investigated.

Results: A total of 94,349 repairs were analyzed, with 5401 (5%) emergency repairs. Emergency repairs involved older patients (median age 74 vs. 65), more women (25% vs. 9%), more ASA grade III (38% vs. 12%), more femoral hernias (19% vs. 3%) and smaller defects (24% vs. 17%) compared to elective repairs. Multivariable analysis revealed increased rates and significant risks for 30-day mortality (2.7%, OR 11.61), chronic pain (20.6%, OR 1.30), 30-day postoperative complications (21.9%, OR 2.12) and bowel resection (7.8%, OR 408) compared to elective repairs. No significant difference was observed for reoperation for recurrence. Key risk factors for the outcomes following emergency repairs were higher age, higher ASA grade and femoral hernias.

Conclusions: Emergency hernia surgery continues to pose a high risk of mortality and morbidity. Elective repair should be considered in frail patients and those with potential femoral hernias.