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Mortality after emergency versus elective groin hernia repair: a systematic review and meta-analysis

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Abstract

Background

Emergency groin hernia repair is associated with increased mortality risk, but the actual risk is unknown. Therefore, this review aimed to investigate 30- and 90-day postoperative mortality in adult patients who had undergone emergency or elective groin hernia repair.

Methods

This review was reported following PRISMA 2020 guidelines, and a protocol (CRD42021244412) was registered to PROSPERO. A systematic search was conducted in PubMed, EMBASE, and Cochrane CENTRAL in April 2021. Studies were included if they reported 30- or 90-day mortality following an emergency or elective groin hernia repair. Meta-analyses were conducted when possible, and subgroup analyses were made for bowel resection, sex, and hernia type. According to the study design, the risk of bias was assessed using either the Newcastle–Ottawa Scale or Cochrane Risk of Bias tool.

Results

Thirty-seven studies with 30,740 patients receiving emergency repair and 457,253 receiving elective repair were included. The 30-day mortality ranged from 0–11.8% to 0–1.7% following emergency and elective repair, respectively. The risk of 30-day mortality following emergency repair was estimated to be 26-fold higher than after elective repair (RR = 26.0, 95% CI 21.6–31.4, I2 = 0%). A subgroup meta-analysis on bowel resection in emergency repair estimated 30-day mortality to be 7.9% (95% CI 6.5–9.3%, I2 = 6.4%). Subgroup analyses on sex and hernia type showed no differences regarding the mortality risk in elective surgery. However, femoral hernia and female sex significantly increased the risk of mortality in emergency surgery, both given by a risk ratio of 1.7.

Conclusion

The overall mortality after emergency groin hernia repair is 26-fold higher than after elective repair, but the increased risk is attributable mostly to female and femoral hernias.

Trial registration

PROSPERO protocol (CRD42021244412).

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Data availability

All data are reported in the article, or electronic resources, why there are no supplementary data for data sharing.

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Authors and Affiliations

  1. Center for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark

    Ann Hou Sæter, Siv Fonnes, Jacob Rosenberg & Kristoffer Andresen

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  1. Ann Hou Sæter
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  2. Siv Fonnes
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Correspondence to Ann Hou Sæter.

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Authors Ann Hou Sæter, Siv Fonnes, Jacob Rosenberg, and Kristoffer Andresen have no conflicts of interest or financial ties to disclose.

Ethical approval

A protocol was registered in PROSPERO (CRD42021244412) before data extraction and can be accessed here https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=244412 [10].

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Supplementary Information

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Supplementary file1 (DOCX 142 kb). Supplementary File 1. Search strategies for all databases

Supplementary file2 (DOCX 24 kb). Supplementary File 2. Summary of findings table

Supplementary file3 (DOCX 29 kb). Supplementary Table. Patient characteristics of the included studies

464_2022_9327_MOESM4_ESM.jpg

Supplementary file4 (JPG 26 kb). Supplementary Figure. Risk of bias assessment for the included randomised controlled trials. “+” indicates a low risk of bias, “?” indicates an unclear risk of bias, and “–“indicates a high risk of bias

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Sæter, A.H., Fonnes, S., Rosenberg, J. et al. Mortality after emergency versus elective groin hernia repair: a systematic review and meta-analysis. Surg Endosc 36, 7961–7973 (2022). https://doi.org/10.1007/s00464-022-09327-2

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