Mortality after emergency versus elective groin hernia repair: a systematic review and meta-analysis.

BACKGROUND: Emergency groin hernia repair is associated with increased mortality risk, but the actual risk is unknown. Therefore, this review aimed to investigate 30- and 90-day postoperative mortality in adult patients who had undergone emergency or elective groin hernia repair. METHODS: This review was reported following PRISMA 2020 guidelines, and a protocol (CRD42021244412) was registered to PROSPERO. A systematic search was conducted in PubMed, EMBASE, and Cochrane CENTRAL in April 2021. Studies were included if they reported 30- or 90-day mortality following an emergency or elective groin hernia repair. Meta-analyses were conducted when possible, and subgroup analyses were made for bowel resection, sex, and hernia type. According to the study design, the risk of bias was assessed using either the Newcastle-Ottawa Scale or Cochrane Risk of Bias tool. RESULTS: Thirty-seven studies with 30,740 patients receiving emergency repair and 457,253 receiving elective repair were included. The 30-day mortality ranged from 0-11.8% to 0-1.7% following emergency and elective repair, respectively. The risk of 30-day mortality following emergency repair was estimated to be 26-fold higher than after elective repair (RR = 26.0, 95% CI 21.6-31.4, I2 = 0%). A subgroup meta-analysis on bowel resection in emergency repair estimated 30-day mortality to be 7.9% (95% CI 6.5-9.3%, I2 = 6.4%). Subgroup analyses on sex and hernia type showed no differences regarding the mortality risk in elective surgery. However, femoral hernia and female sex significantly increased the risk of mortality in emergency surgery, both given by a risk ratio of 1.7. CONCLUSION: The overall mortality after emergency groin hernia repair is 26-fold higher than after elective repair, but the increased risk is attributable mostly to female and femoral hernias. TRIAL REGISTRATION: PROSPERO protocol (CRD42021244412).

High complication and mortality rates after emergency groin hernia repair: a nationwide register-based cohort study.

PURPOSE: Emergency groin hernia is an understudied research field despite its severity requiring emergency surgery associated with high postoperative morbidity and mortality rates. Therefore, this study aimed to investigate the characteristics of patients, hernias, and surgical repairs, as well as complication rates following emergency groin hernia repair. METHODS: Nationwide cohort study based on prospectively collected data obtained from the Danish Hernia Database and person-level linked to the Danish National Patient Registry. We included all adult patients undergoing an emergency groin hernia repair for inguinal- and/or femoral hernias registered in the Danish Hernia Database between January 1, 1998, and December 31, 2020. Primary outcomes were 30- and 90-day mortality, 30- and 90-day readmissions, and reoperations for recurrence. Outcomes were presented as crude numbers, odds ratios for mortality and readmission, and hazard ratios for reoperation. RESULTS: We included 9741 patients in the study. Within 30 days of surgery, 510 (6%) deaths and 1800 (23%) readmissions were recorded. During a median follow-up of 5 years, 537 (6%) reoperations for recurrence were performed. Multivariate analyses showed that mortality and readmission rates were influenced by increasing age, comorbidity, and bowel resection. Cumulative and adjusted reoperation rates were lower for mesh than non-mesh repairs. Moreover, mortality rates have improved over time, whereas readmission rates have increased over time. CONCLUSIONS: Complication and mortality rates after emergency groin hernia repair remain high. This study underlines the importance of a timely repair in incarcerated hernias to avoid contaminated surgical fields and the need for bowel resection.