Linked hospital and primary care database analysis of the impact of short-term complications on recurrence in laparoscopic inguinal hernia repair

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Title: Linked hospital and primary care database analysis of the impact of short-term complications on recurrence in laparoscopic inguinal hernia repair
Authors: Bouras, G
Burns, EM
Howell, AM
Bottle, A
Athanasiou, T
Darzi, A
Item Type: Journal Article
Abstract: Objective: To study the effects of short-term complications on recurrence following laparoscopic inguinal hernia repair using routine data. Background: Linked primary and secondary care databases can evaluate the quality of inguinal hernia surgery by quantifying short- and long-term outcome together. Methods: Longitudinal analysis of linked primary care (Clinical Practice Research Datalink) and hospital administrative (Hospital Episodes Statistics) databases quantified 30-day complications (wound infection and bleeding) and surgery for recurrence after primary repair performed between 1st April 1997 and 31st March 2012. Results: Out of 41,545 primary inguinal hernia repairs, 10.3% (4296/41,545) were laparoscopic. Complications were less frequent following laparoscopic (1.8%, 78/4296) compared with open (3.5%, 1288/37,249) inguinal hernia repair (p < 0.05). Recurrence was more frequent following laparoscopic (3.5%, 84/2541) compared with open (1.2%, 366/31,859) repair (p < 0.05). Time to recurrence was shorter for laparoscopic (26.4 months SD 28.5) compared with open (46.7 months SD 37.6) repair (p < 0.05). Overall, complications were associated with recurrence (3.2%, 44/1366 with complications; 1.7%, 700/40,179 without complications; p < 0.05). Complications did not significantly increase the risk of recurrence in open hernia repair (OR = 1.49; 95% CI 0.97−2.30, p = 0.069). Complications following laparoscopic repair was significantly associated with increased risk of recurrence (OR = 7.86; 95% CI 3.46−17.85, p < 0.05). Conclusions: Complications recorded in linked routine data predicted recurrence following laparoscopic inguinal hernia repair. Focus must, therefore, be placed on achieving good short-term outcome, which is likely to translate to better longer term results using the laparoscopic approach.
Issue Date: 27-Jan-2017
Date of Acceptance: 6-Jan-2017
URI: http://hdl.handle.net/10044/1/48023
DOI: https://dx.doi.org/10.1007/s10029-017-1575-1
ISSN: 1265-4906
Publisher: SPRINGER
Start Page: 191
End Page: 198
Journal / Book Title: HERNIA
Volume: 21
Issue: 2
Copyright Statement: © 2017 Springer-Verlag France. The final publication is available at https://dx.doi.org/10.1007/s10029-017-1575-1
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
Inguinal hernia repair
Complications
Recurrence
Primary care
Laparoscopy
Database
QUALITY-OF-LIFE
SURGERY
LICHTENSTEIN
METAANALYSIS
POPULATION
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine
Epidemiology, Public Health and Primary Care



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