Patient-reported adverse events after hernia surgery and socio-economic status: A register-based cohort study.
BACKGROUND
The aim of the present study was to assess how socio-economic background influences perception of an adverse postoperative event after hernia surgery, and to see if this affects the pattern of seeking healthcare advice during the early postoperative period.


METHODS
All patients aged 15 years or older with a primary unilateral inguinal or femoral hernia repair recorded in the Swedish Hernia Register (SHR) between November 1 and December 31, 2002 were sent a questionnaire inquiring about adverse events. Data on civil status, income, level of education and ethnic background were obtained from Statistics Sweden.


RESULTS
Of the 1643 patients contacted, 1440 (87.6%) responded: 1333 (92.6%) were men and 107 (7.4%) women, mean age was 59 years. There were 203 (12.4%) non-responders. Adverse events were reported in the questionnaire by 390 (27.1%) patients. Patients born in Sweden and patients with high income levels reported a significantly higher incidence of perceived adverse events (p < 0.05). Patients born in Sweden and females reported more events requiring healthcare contact. There was no association between registered and self-reported outcome and civil status or level of education.


CONCLUSIONS
We detected inequalities related to income level, gender and ethnic background. Even if healthcare utilization is influenced by socio-economic background, careful information of what may be expected in the postoperative period and how adverse events should be managed could lead to reduced disparity and improved quality of care in the community at large.
Department of Surgery, Karolinska University Hospital Huddinge, Vårdarvägen 1, SE-141 52 Huddinge, Stockholm Sweden. Electronic address: agnes.wefer@gmail.com.
Agnes
A
Wefer
Department of Surgical and Perioperative Sciences, Umeå University, SE-901 87 Umeå, Sweden. Electronic address: ulf.gunnarsson@ki.se.
Ulf
U
Gunnarsson
Department of Clinical Science, Intervention and Technology, Karolinska Institute, Alfred Nobels Allé 8, SE-141 52 Huddinge, Stockholm, Sweden. Electronic address: ulf.franneby@ki.se.
Ulf
U
Fränneby
Department of Clinical Science, Intervention and Technology, Karolinska Institute, Alfred Nobels Allé 8, SE-141 52 Huddinge, Stockholm, Sweden. Electronic address: gabriel.sandblom@ki.se.
Gabriel
G
Sandblom
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006550:Hernia, Femoral / Q000453:epidemiology / Q000601:surgery*; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D057566:Self Report; D012923:Social Class; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology
Access to health; Inguinal hernia; Post-operative complications; Social background