Population-based study of presentation and adverse outcomes after femoral hernia surgery.
BACKGROUND
Rates of emergency admission with femoral hernia are high compared with those for other hernias. This study aimed to determine the modes and consequences of presentation to primary care before admission to hospital.


METHODS
This was a population-based cohort study using healthcare records from the Clinical Practice Research Datalink linked to Hospital Episode Statistics data from 1997 to 2007. Length of hospital stay, bowel resection rates and 30-day mortality were calculated.


RESULTS
A total of 885 patients (690 female, 78.0 per cent) underwent femoral hernia repair, with 406 operations (45·9 per cent) performed as an emergency. The majority of patients who were admitted as an emergency (331, 81·5 per cent) presented to the general practitioner for the first time with symptoms of a hernia in the 7 days before admission, compared with just ten (2·1 per cent) of 479 patients admitted electively (P < 0·001). The median (i.q.r.) length of stay for patients undergoing elective surgery was 1 (0-2) day compared with 5 (3-9) days for those having an emergency repair (P < 0·001). Adverse events were more common among patients operated on as emergency, with 94 (23·2 per cent) having a small bowel resection compared with one (0·2 per cent) who had elective surgery. There were no deaths within 30 days in the elective group, but seven (1·7 per cent) in the emergency group.


CONCLUSIONS
A large proportion of patients with femoral hernia present late to primary care and are operated on as an emergency, with worse outcomes.
Nottingham Digestive Disease Centre and Biomedical Research Unit, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK; Division of Epidemiology and Public Health, Nottingham City Hospital, Nottingham, UK.
D J
DJ
Humes
R S
RS
Radcliffe
C
C
Camm
J
J
West
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D006550:Hernia, Femoral / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007421:Intestine, Small / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D016896:Treatment Outcome