Duration and magnitude of postoperative risk of venous thromboembolism after planned inguinal hernia repair in men: a population-based cohort study

Abstract

Purpose

Little is known regarding the magnitude and timing of the risk of VTE following inguinal hernia surgery. We aimed to determine the absolute and relative rates of venous thromboembolism (VTE) following planned inguinal hernia repair.

Methods

We analysed male adults with a first inguinal hernia repair with no prior record of VTE from the Clinical Practice Research Datalink, linked to the Hospital Episode Statistics (2001–2011). Crude rates and adjusted hazard ratios (HR) of the first VTE were calculated using Cox regression analysis to compare specific time periods following the surgery compared to the general population.

Results

We identified 28,782 men who underwent an inguinal hernia repair with 53 (0.18%) having a first VTE in the 90 days following surgery. The overall rate of VTE in the first 90 days following surgery was 7.61 per 1000 person years (pyrs) (95% CI 5.82–9.96). Increasing age, a body mass index > 30 kg/m2 and an in-patient procedure were associated with an increased risk of VTE, when compared to the general population. The risk of VTE was highest in the 1st month following the surgery with a 2.3- (aHR 2.33; 95% CI 1.09–4.99) and 3.5- (aHR 3.47; 95% CI 2.07–5.83) fold increased risk compared to the general population for both day case and planned in-patient procedures, respectively.

Conclusions

Reassuringly, the absolute rates of VTE following inguinal hernia repair are low. Patients should be informed that their peak risk of VTE is during the 1st month following the surgery. Further studies on the optimum duration of thromboprophylaxis following surgery are required in high-risk patients undergoing hernia repair.

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Funding

The work was funded by an National Institute for Health Research Post-Doctoral Fellowship awarded to DJH.

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All the authors have had access to the data and contributed to the drafting of the paper.

Corresponding author

Correspondence to D. J. Humes.

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The authors declare that they have no competing interest.

Ethical approval

The Independent Scientific Advisory Committee approval board which provides scientific advice to the Medicines and Healthcare products Regulatory Agency (MHRA) approved the study (Protocol 11-051R).

Human and animal rights

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

Informed consent

Considering the design of our study, patient consent was not required.

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Humes, D.J., Abdul-Sultan, A., Walker, A.J. et al. Duration and magnitude of postoperative risk of venous thromboembolism after planned inguinal hernia repair in men: a population-based cohort study. Hernia 22, 447–453 (2018). https://doi.org/10.1007/s10029-017-1716-6

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Keywords

  • Venous thrombosis
  • Inguinal hernia
  • Surgery