NELA.02Trends in management and outcomes for patients presenting acutely with inguinal hernia

Abstract

Abstract Aims Rates of emergency inguinal hernia presentations are increasing as ‘watch and wait’ management approaches become more popular. This study aimed to review current practice regarding clinical management of patients admitted acutely with an inguinal hernia in the North of England. Methods Patients ≥18 years admitted acutely with an inguinal hernia between 2002-2016 to North of England NHS trusts were identified. Data on demographics, investigations and operative interventions was collected. Outcomes analysed included rate of bowel resection, length of stay (LoS) and 30-day postoperative mortality. Results A total of 4698 patients presented acutely with an inguinal hernia, and 2588 patients (55.0%) underwent emergency surgery. Pre-operative CT scanning increased from 1.0% (2002-2006) to 12.1% (2012-2016) (p < 0.001). Patients who had a pre-operative CT were less likely to undergo repair than those who did not (42.2% vs. 56.0%, p < 0.001). Rates of bowel resection were higher in patients who had a CT (9.6% vs. 2.7%, p < 0.001). Of those presenting with obstructive symptoms, only 5.7% required bowel resection, 85.7% of these being small bowel. Bowel resection was associated with increased LoS (p < 0.001) and 30-day postoperative mortality (18.8% vs. 2.0%, p < 0.001). Laparoscopic repair, used in 119 procedures (4.6%), was associated with shorter mean LoS compared with open repair (3.0 vs 4.4 days, p < 0.001) but no difference in 30-day mortality (p = 0.169). Conclusions Emergency inguinal hernia repairs, requiring bowel resection, are associated with significantly increased LoS and a 9-fold increase in 30-day mortality. These findings raise important aspects to be discussed with patients during the consent process.