Anaesthesia and post-operative morbidity after elective groin hernia repair: a nation-wide study.
BACKGROUND
Randomised studies suggest regional anaesthesia to have the highest morbidity and local infiltration anaesthesia to have the lowest morbidity after groin hernia repair. However, implications and results of this evidence for general practice are not known.


METHODS
Prospective nation-wide data collection in a cohort of n=29,033 elective groin hernia repairs, registered in the Danish Hernia Database in three periods, namely July 1998-June 1999, July 2000-June 2001 and July 2002-June 2003. Retrospective analysis of complications in discharge abstracts, identified from re-admission within 30 days post-operatively, prolonged length of stay (>2 days post-operatively) or death.


RESULTS
Complications after groin hernia repair were more frequent in patients 65+ years (4.5%), compared with younger patients (2.7%) (P<0.001). In patients 65+ years, medical complications were more frequent after regional anaesthesia (1.17%), compared with general anaesthesia (0.59%) (P=0.003) and urological complications were more frequent after regional anaesthesia (0.87%), compared with local infiltration anaesthesia (0.09%) (P=0.006). Seventeen prostatectomies occurred after post-operative urinary retention, but with no case after local anaesthesia. Mortality within 30 days after elective groin hernia repair was 0.12%. Regional anaesthesia was disproportionately more often used in patients dying within 1 week post-operatively.


CONCLUSIONS
Choice of the anaesthetic technique should be adjusted to available procedure-specific scientific evidence and the use of regional anaesthesia in elderly patients undergoing groin hernia repair is not supported by existing evidence.
Bay-Nielsen
M
M
The Danish Hernia Database, Department of Gastroenterology, University Hospital, Hvidovre, Denmark. morten.bay.Nielsen@hvh.regionh.dk
Kehlet
H
H
D000367:Age Factors; D000368:Aged; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000401:mortality; D000768:Anesthesia, General / Q000009:adverse effects / Q000401:mortality; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D017558:Elective Surgical Procedures / Q000379:methods*; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000139:chemically induced*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D016055:Urinary Retention / Q000139:chemically induced