title: Linked hospital and primary care database analysis of the impact of short-term complications on recurrence in laparoscopic inguinal hernia repair.
abstract: To study the effects of short-term complications on recurrence following laparoscopic inguinal hernia repair using routine data.
  
  
  
  Linked primary and secondary care databases can evaluate the quality of inguinal hernia surgery by quantifying short- and long-term outcome together.
  
  
  
  Longitudinal analysis of linked primary care (Clinical Practice Research Datalink) and hospital administrative (Hospital Episodes Statistics) databases quantified 30-day complications (wound infection and bleeding) and surgery for recurrence after primary repair performed between 1st April 1997 and 31st March 2012.
  
  
  
  Out of 41,545 primary inguinal hernia repairs, 10.3% (4296/41,545) were laparoscopic. Complications were less frequent following laparoscopic (1.8%, 78/4296) compared with open (3.5%, 1288/37,249) inguinal hernia repair (p < 0.05). Recurrence was more frequent following laparoscopic (3.5%, 84/2541) compared with open (1.2%, 366/31,859) repair (p < 0.05). Time to recurrence was shorter for laparoscopic (26.4 months SD 28.5) compared with open (46.7 months SD 37.6) repair (p < 0.05). Overall, complications were associated with recurrence (3.2%, 44/1366 with complications; 1.7%, 700/40,179 without complications; p < 0.05). Complications did not significantly increase the risk of recurrence in open hernia repair (OR = 1.49; 95% CI 0.97-2.30, p = 0.069). Complications following laparoscopic repair was significantly associated with increased risk of recurrence (OR = 7.86; 95% CI 3.46-17.85, p < 0.05).
  
  
  
  Complications recorded in linked routine data predicted recurrence following laparoscopic inguinal hernia repair. Focus must, therefore, be placed on achieving good short-term outcome, which is likely to translate to better longer term results using the laparoscopic approach.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK. g.bouras@imperial.ac.uk.
authors.forename: G
authors.initials: G
authors.lastname: Bouras
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Burns
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Howell
authors.affiliation: Dr Foster Unit, Department of Primary Care and Public Health, Imperial College, Charing Cross Hospital, 3 Dorset Rise, London, EC4Y 8EN, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bottle
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Athanasiou
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Complications; Database; Inguinal hernia repair; Laparoscopy; Primary care; Recurrence