Risk factors and outcomes of acute versus elective groin hernia surgery

J Am Coll Surg. 2011 Sep;213(3):363-9. doi: 10.1016/j.jamcollsurg.2011.05.008. Epub 2011 Jun 15.


Background: Hernia characteristics and patient factors associated with acute compared with elective groin hernia surgery are unknown.

Study design: A retrospective study of 1,034 consecutive groin hernia repair cases performed between 2001 and 2009 at a single Veterans Affairs Hospital was conducted. Patient variables, hernia characteristics, time to surgery, and morbidity and mortality outcomes were abstracted and compared between acute and elective hernia repairs. A Kaplan-Meier survival analysis for the two groups was also performed. Logistic regression analysis was conducted to identify associations between type of surgery, patient demographics, and hernia characteristics.

Results: Compared with 971 elective repair patients, the 63 acute repair patients had a higher rate of femoral hernias (2.5% vs 7.4%, p = 0.03), a higher rate of scrotal hernias (16.2% vs 32.4%, p = 0.0006), and a higher rate of recurrent hernias (16.7% vs 30.9%, p = 0.0026). Patient age, femoral, scrotal, and recurrent hernias were significantly associated with acute hernia presentation on univariate and multivariable analyses. Complications occurred in 27% and 15.1% of acute and elective repair patients, respectively (p = 0.01). Intraoperative organ resection was required in 7 (11.1%) acute hernia repairs, and in 2 (0.2%) elective repairs (p < 0.0001). Three acute repair patients (4.8%) underwent reoperation within 30 days after surgery, compared with 15 elective repair patients (1.5%), p = 0.05. Age-adjusted Kaplan-Meier survival analysis revealed a shorter time to death among acute repair patients compared with elective repair patients (p < 0.0001).

Conclusions: Age, femoral, scrotal, and recurrent groin hernias are associated with increased risk for acute hernia surgery. Acute hernia repair carries a higher morbidity and lower survival.

MeSH terms

  • Acute Disease
  • Aged
  • Boston
  • Chi-Square Distribution
  • Elective Surgical Procedures
  • Female
  • Hernia, Abdominal / surgery*
  • Hospitals, Veterans
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis
  • Treatment Outcome