Skip to main content
Log in

Surgical and non-surgical treatment of inguinal hernia during non-elective admissions in the Nationwide Readmissions Database

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

A Correction to this article was published on 27 July 2021

This article has been updated

Abstract

Introduction

Inguinal hernia repair is one of the most common surgical operations, yet the optimal treatment strategy remains undefined. Treatment of symptomatic inguinal hernias include both surgical and non-surgical approaches. The objective of this study was to determine differences in population, readmission rates, and costs between operative and non-operative approaches for patients admitted non-electively for an inguinal hernia in a national dataset. In addition, we sought to define the baseline characteristics of the two groups and identify potential predictive factors in the non-surgically managed subgroup who were readmitted and treated operatively within 90 days of their first visit.

Methods

This study was a retrospective review of data from the Nationwide Readmissions Database (NRD) from 2010 to 2014. Patients above age 18 who were admitted non-electively for a primary diagnosis of inguinal hernia were included. Patients whose length of stay was < 1% or > 95% percentile or died during the initial visit were excluded. Readmissions within 90 days of the initial visit were flagged. Patients were classified according to initial management strategy: operative versus non-operative. Demographic, clinical, and organizational characteristics were compared between the two cohorts.

Results

14,249 patients met inclusion criteria and were operative (n = 8996, 63.13%) and non-operative (n = 5255, 36.88%) cohorts. When comparing the two groups, readmission rate was lower (0.49% for surgical, 1.78% for non-surgical, p < 0.01), mean length of stay (LOS) longer (3.27 [SE = 0.05] days for surgical, 2.76 days [SE = 0.06] for non-surgical, p < 0.01), and mean total cost higher ($9597 for surgical, $7167 for non-surgical, p < 0.01) in surgically treated patients. The non-surgical population was on average older (63.05 years for surgical, 64.52 years for non-surgical, p < 0.01) with more chronic conditions (3.57 for surgical, 4.05 for non-surgical, p < 0.01). Of the patients initially managed non-surgically, 1.78% (n = 91) were readmitted, and of them, 62.63% (n = 57) were readmitted and managed surgically within 90 days of initial admission (i.e., crossed over from watchful waiting to surgical treatment). Average number of chronic conditions (3.79 versus 4.03, p = 0.74), average number of comorbidities (2.26 versus 2.18, p = 0.87), and average total number of ICD-9 discharge codes (7.44 versus 8.23 p = 0.54 did not differ significantly between the operative versus non-operative sample of the readmitted population. The total cost ($5562.38 versus $8737.28, p = 0.01) was greater in the operative versus non-operative sample.

Conclusion

Watchful-waiting strategy is the most common treatment approach in patients admitted non-electively for symptomatic inguinal hernia. Readmission after non-elective hospitalization for inguinal hernia is rare, but surgical intervention decreased the likelihood of readmission compared to non-operative management, while also increasing LOS and cost of care. Our data supports a patient centric approach to the management; non-surgical treatment is a viable temporary option even in symptomatic inguinal hernias, while surgical treatment may reduce the likelihood of future readmission.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Change history

References

  1. Primatesta P, Goldacre MJ (1996) Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 25(4):835–839

    Article  CAS  Google Scholar 

  2. Jenkins JT, Patrick JO (2008) Inguinal hernias. BMJ 336(7638):269–272

  3. Fitzgibbons RJ et al (2006) Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. Jama 295(3):285–292 (2006)

  4. Davies M et al (2007) Emergency presentation of abdominal hernias: outcome and reasons for delay in treatment—a prospective study. Ann R Coll Surg Engl 89(1):47–50 (2007)

  5. National Readmission Database (2010–2014) Healthcare cost and utilization project (HCUP). Agency for Healthcare Research and Quality, Rockville. https://www.hcup-us.ahrq.gov/db/nation/nrd/nrddbdocumentation.jsp

  6. Mizrahi H, Parker MC (2012) Management of asymptomatic inguinal hernia: a systematic review of the evidence. Arch Surg 147(3):277–281

    Article  Google Scholar 

  7. Cunningham J et al (1996) Cooperative hernia study. Pain in the postrepair patient. Ann Surg 224(5):598 (1996)

  8. Sarosi GA et al (2011) A clinician's guide to patient selection for watchful waiting management of inguinal hernia. Ann Surg 253(3):605–610

  9. Gong W, Li J (2018) Operation versus watchful waiting in asymptomatic or minimally symptomatic inguinal hernias: the meta-analysis results of randomized controlled trials. Int J Surg 52:120–125

    Article  Google Scholar 

  10. Fitzgibbons Jr RJ et al (2013) Long-term results of a randomized controlled trial of a non-operative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg 258(3):508–515

  11. Chung L et al (2011) Long-term follow-up of patients with a painless inguinal hernia from a randomized clinical trial*. Br J Surg 98(4):596–599. https://doi.org/10.1002/bjs.7355

    Article  CAS  PubMed  Google Scholar 

  12. Oyasiji T et al (2010) Small bowel obstruction: outcome and cost implications of admitting service. Am Surg 76(7):687–691

  13. Bilderback PA et al (2015) Small bowel obstruction is a surgical disease: patients with adhesive small bowel obstruction requiring operation have more cost-effective care when admitted to a surgical service. J Am Coll Surg 221(1):7–13

  14. Friis-Andersen H, Bisgaard T (2016) The Danish Inguinal Hernia database. Clin Epidemiol 8(521–524):25. https://doi.org/10.2147/CLEP.S99512

    Article  Google Scholar 

  15. Nilsson E, Haapaniemi S (2000) The Swedish hernia register: an eight year experience. Hernia 4:286–289. https://doi.org/10.1007/BF01201085

    Article  Google Scholar 

  16. Stechemesser B, Jacob DA, Schug-Paß C, Köckerling F (2012) Herniamed: an internet-based registry for outcome research in hernia surgery. Hernia 16(3):269–276. https://doi.org/10.1007/s10029-012-0908-3

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

KWS conceived of the presented idea. SK, RR, HJ, and KWS verified the analytical methods. RR, SK, and KWS performed the analytic calculations. HD, HKJ and KWS took the lead in drafting the manuscript. All authors discussed the results and reviewed and edited the final manuscript.

Corresponding author

Correspondence to H. K. Jensen.

Ethics declarations

Conflict of interest

None of the authors report any personal or financial conflict of interest.

Ethical approval

Approval from the institutional review board was not required for this study in a limited dataset, as it was deemed exempt by the UAMS IRB.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original article has been updated: Due to Abstract update.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Drolshagen, H., Bhavaraju, A., Kalkwarf, K.J. et al. Surgical and non-surgical treatment of inguinal hernia during non-elective admissions in the Nationwide Readmissions Database. Hernia 25, 1259–1264 (2021). https://doi.org/10.1007/s10029-021-02441-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-021-02441-5

Keywords

Navigation