title: A national trainee-led audit of inguinal hernia repair in Scotland.
abstract: OBJECTIVE
  This audit assessed inguinal hernia surgery in Scotland and measured compliance with British Hernia Society Guidelines (2013), specifically regarding management of bilateral and recurrent inguinal hernias. It also assessed the feasibility of a national trainee-led audit, evaluated regional variations in practise and gauged operative exposure of trainees.
  
  
  METHODS
  A prospective audit of adult inguinal hernia repairs across every region in Scotland (30 hospitals in 14 NHS boards) over 2-weeks was co-ordinated by the Scottish Surgical Research Group (SSRG).
  
  
  RESULTS
  235 patients (223 male, median age 61) were identified and 96 % of cases were elective. Anaesthesia was 91 % general, 5 % spinal and 3 % local. Prophylactic antibiotics were administered in 18 %. Laparoscopic repair was used in 33 % (30 % trainee-performed). Open repair was used in 67 % (42 % trainee-performed). Elective primary bilateral hernia repairs were laparoscopic in 97 % while guideline compliance for an elective recurrence was 77 %. For elective primary unilateral hernias, the use of laparoscopic repair varied significantly by region (South East 43 %, North 14 %, East 7 % and West 6 %, p < 0.001) as did repair under local anaesthesia for open cases (North 21 %, South East 4 %, West 2 % and East 0 %, p = 0.001). Trainees independently performed 9 % of procedures. There were no significant differences in trainee or unsupervised trainee operator rates between laparoscopic and open cases. Mean hospital stay was 0.7-days with day case surgery performed in 69 %.
  
  
  CONCLUSIONS
  This trainee-lead audit provides a contemporary view of inguinal hernia surgery in Scotland. Increased compliance on recurrent cases appears indicated. National re-audit could ensure improved adherence and would be feasible through the SSRG.
authors.affiliation: Scottish Surgical Research Group, Royal College of Surgeons Edinburgh, Edinburgh, Midlothian, EH8 9DW, Scotland. stephenoneill@doctors.org.uk.|MRC Centre for Inflammation Research, Tissue Injury and Repair Group, University of Edinburgh, Chancellor's Building, Royal Infirmary of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SA, UK. stephenoneill@doctors.org.uk.
authors.forename: S
authors.initials: S
authors.lastname: O'Neill
authors.affiliation: Scottish Surgical Research Group, Royal College of Surgeons Edinburgh, Edinburgh, Midlothian, EH8 9DW, Scotland.
authors.forename: A G
authors.initials: AG
authors.lastname: Robertson
authors.affiliation: Scottish Surgical Research Group, Royal College of Surgeons Edinburgh, Edinburgh, Midlothian, EH8 9DW, Scotland.
authors.forename: A J
authors.initials: AJ
authors.lastname: Robson
authors.affiliation: Scottish Surgical Research Group, Royal College of Surgeons Edinburgh, Edinburgh, Midlothian, EH8 9DW, Scotland.
authors.forename: C H
authors.initials: CH
authors.lastname: Richards
authors.affiliation: Scottish Surgical Research Group, Royal College of Surgeons Edinburgh, Edinburgh, Midlothian, EH8 9DW, Scotland.
authors.forename: G A
authors.initials: GA
authors.lastname: Nicholson
authors.affiliation: Scottish Surgical Research Group, Royal College of Surgeons Edinburgh, Edinburgh, Midlothian, EH8 9DW, Scotland.
authors.forename: D
authors.initials: D
authors.lastname: Mittapalli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000772:Anesthesia, Local; D054869:Clinical Audit; D017558:Elective Surgical Procedures; D005260:Female; D013502:General Surgery / Q000193:education; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012008:Recurrence; D012606:Scotland; D055815:Young Adult
keywords: Audit; Inguinal hernia; Laparoscopic; Open; Scotland; Surgery