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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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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.

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Correspondence to G. Bouras.

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GB declares no conflicts of interest directly related to the submitted work. EMB declares no conflicts of interest directly related to the submitted work. AMH declares no conflicts of interest directly related to the submitted work. AB declares no conflicts of interest directly related to the submitted work. TA declares no conflicts of interest directly related to the submitted work. AD declares no conflicts of interest directly related to the submitted work.

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Ethics approval was granted by the London Westminster Research Ethics Committee (reference number 13/LO/1374).

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

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Bouras, G., Burns, E.M., Howell, A.M. et al. Linked hospital and primary care database analysis of the impact of short-term complications on recurrence in laparoscopic inguinal hernia repair. Hernia 21, 191–198 (2017). https://doi.org/10.1007/s10029-017-1575-1

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