SP7.2.6 Where is the nerve? Review of operation note documentation practice for inguinal hernia repair

Abstract

Abstract Introduction Careful identification and management of inguinal nerves during inguinal hernia repair is important to avoid iatrogenic injury. Documentation of this practice informs postoperative clinical management. We set out to investigate how often surgeons identify inguinal nerves and document findings and management in operation notes. Methods Retrospective review of operation notes at single District General Hospital (DGH). Operation notes analysed for documentation of identification and intraoperative management (preservation vs sacrifice) of the inguinal nerves: iliohypogastric, ilioinguinal and genital branch of genitofemoral nerve. Data including baseline characteristics of each patient, hernia characteristics, and primary operating surgeon ascertained for subgroup analysis. Results A total of 100 patients were included in the analysis. Identification of any of the inguinal nerves (generic - “nerve”) was documented in 17% of operation notes. Documentation of named individual nerves in operation notes was limited. No documentation of intraoperative management of inguinal nerves found in 83% of operation notes. Preservation of the inguinal nerves (generic - “nerve”) was recorded in 8% and sacrifice recorded in 9% of cases. Subgroup analysis revealed similar incidence of documentation of identification and management of inguinal nerves across grades of primary surgeon, with overall incidence low for all grades. Conclusion This study has revealed a lack of appreciation of the importance of documentation of identification and intraoperative management of inguinal nerves in operation notes. Further consideration of the potential implications of poor documentation would be beneficial to improve standards.