Do guidelines influence results in inguinal hernia treatment? A descriptive study of 2,535 hernia repairs in one teaching hospital from 1994 to 2004.
BACKGROUND
The Onze Lieve Vrouwe Gasthuis (OLVG) hospital is a large district teaching hospital with a residency programme for general surgery. Since 1998, inguinal hernia (IH) repairs in this hospital were performed according to the preliminary "evidence-based guidelines" concerning IH repair. The aim of this study was to analyse whether the use of the guidelines improves the quality of IH repair measured by a reduction of the operated recurrences, especially from the patients who underwent the previous repair in this hospital.


METHODS
A retrospective study was performed which included all male adults (>18 years of age) undergoing IH surgery in the OLVG hospital for a primary or recurrent inguinal hernia from 1994 until 2004.


RESULTS
The use of mesh for primary hernia increased significantly from 0.6% in 1994 to 100% in 2004 (P < 0.001). The number of operations performed for recurrent IH fluctuated between 7% and almost 18%. However, the tendency towards a decrease in recurrence is clearly demonstrated by comparing the average recurrence rates of two time periods, namely, 1994-1998 (15.8%) and 2002-2004 (10.6%), proving a significant decrease (P < 0.002). The decreasing portion of recurrences previously operated in the study hospital from 64.3% (1994) to 14.3% (2004) was striking (P < 0.001). The prior operation performed before the recurrence was mesh-based in an average of 42/273 (15.4%) patients and increased each year.


CONCLUSIONS
Between 1994 and 2004, a significant increase in the use of mesh-based techniques for the treatment of IH, influenced by the Dutch evidence-based guidelines, probably resulted in a significant decrease in the number of operations performed for recurrent IH.
Aufenacker
T J
TJ
Department of Surgery, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands. Aufenacker@hetnet.nl
Schmits
S P
SP
Gouma
D J
DJ
Simons
M P
MP
D005260:Female; D013502:General Surgery / Q000193:education*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006552:Hernia, Inguinal / Q000601:surgery*; D006784:Hospitals, Teaching / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic / Q000592:standards*; D019651:Plastic Surgery Procedures / Q000193:education* / Q000295:instrumentation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013526:Surgical Mesh