Mortality after groin hernia surgery: delay of treatment and cause of death.
BACKGROUND
Emergency hernia surgery, in contrast to elective hernia surgery, is associated with appreciable mortality. Incarcerated hernia is the second most common cause of small bowel obstruction after adhesions, and the leading cause of bowel strangulation.


METHODS
Information on patients who died within 30 days of groin hernia surgery was retrieved from the Swedish Hernia Register, from the Cause-of-Death Register, and from hospital notes.


RESULTS
Of 103,710 groin hernia operations between 1992 and 2004, 292 patients died within 30 days of surgery. Hospital notes and cause of death were retrieved for 242 cases (82%). In 5 of these patients, the hernia operation was done in addition to more urgent surgery and therefore excluded from further analyses; 152 patients were admitted as emergency cases and 55 of these patients underwent bowel resection. A total of 107 patients had signs of bowel obstruction when admitted. For 37% of these patients, physical examination of the groin was not documented. Patients with bowel obstruction without a note on a palpable groin lump were more likely to undergo imaging investigation preoperatively (P < 0.001) and they had an increased time to surgery compared to patients with a palpable lump. Women and patients with femoral hernia were significantly less likely to undergo a groin examination compared to other patients. Local anaesthesia was used in 7% of all patients who died postoperatively, and in 3% of emergency cases. Pulmonary disease, sepsis and malignant disease were more common as causes of death after emergency surgery than after elective surgery.


CONCLUSIONS
Groin examination of patients presenting with bowel obstruction is of utmost importance in order to minimise delay to hernia surgery.
Department of Surgery, Sahlgrenska University Hospital, 416 85, Östra, Sjukhuset, Göteborg, Sweden. hanna.nilsson@vgregion.se
H
H
Nilsson
E
E
Nilsson
U
U
Angerås
P
P
Nordin
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003108:Colonic Diseases / Q000209:etiology; D004630:Emergencies; D005260:Female; D006119:Groin; D006550:Hernia, Femoral / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006552:Hernia, Inguinal / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D008297:Male; D010808:Physical Examination; D012042:Registries; D013548:Sweden / Q000453:epidemiology
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