1271 The Management of Acutely Symptomatic Hernia (MASH): A UK Wide Prospective Cohort Study

Abstract

Abstract Introduction Acutely symptomatic abdominal wall and groin hernias (ASH) are a common presentation, accounting for approximately 25% of acute surgical admissions in the UK. There is limited data to guide the treatment of such presentations. This study aimed to assess outcomes of emergency hernia surgery, and identify common management strategies, to improve care for these high-risk patients. Method A 12 week, UK-based, multi-centre, collaborative, prospective cohort study (NCT04197271) recruited adults with ASH. Data on inpatient management, specific surgical intervention, in-hospital morbidity and mortality and quality of life (EQ-5D-5L) was measured. 30 and 90-day follow-up phone calls collected complications and quality of life. Descriptive analyses were performed to describe population and outcomes. Results Twenty-three acute trusts recruited 264 patients. Inguinal (37.9%) and umbilical (37.1%) hernias were most common. 17% were awaiting elective surgery and 17% had been previously declined intervention. 46% were incarcerated at presentation, and 31% symptomatic (painful/irreducible). 82% of patients had operations within 48 hours, with 95% performed open. Mesh was used in 55%, the majority (86%) being synthetic non-absorbable. Sutures used for suture repair varied widely. Complications were infrequent; 2% developed pneumonia or delirium. Surgical site infection occurred in 3% and mortality was 1.2%. Quality of life improved between baseline and 30-days following repair. Conclusions There is variation in the management of ASH in the UK, particularly with repair techniques, use of mesh and laparoscopy. One in five patients was awaiting repair; this might indicate a need for expedited pathways and reprioritising elective hernia repair.