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Mortality After Groin Hernia Surgery

Nilsson, Hanna MD*; Stylianidis, Georgios MD; Haapamäki, Markku MD, PhD; Nilsson, Erik MD, PhD; Nordin, Pär MD, PhD

doi: 10.1097/01.sla.0000251364.32698.4b
Original Articles

Objective: To analyze mortality following groin hernia operations.

Summary Background Data: It is well known that the incidence of groin hernia in men exceeds the incidence in women by a factor of 10. However, gender differences in mortality following groin hernia surgery have not been explored in detail.

Methods: The study comprises all patients 15 years or older who underwent groin hernia repair between January 1, 1992 and December 31, 2005 at units participating in the Swedish Hernia Register (SHR). Postoperative mortality was defined as standardized mortality ratio (SMR) within 30 days, ie, observed deaths of operated patients over expected deaths considering age and gender of the population in Sweden.

Results: A total of 107,838 groin hernia repairs (103,710 operations), were recorded prospectively. Of 104,911 inguinal hernias, 5280 (5.1%) were treated emergently, as compared with 1068 (36.5%) of 2927 femoral hernias. Femoral hernia operations comprised 1.1% of groin hernia operations on men and 22.4% of operations on women. After femoral hernia operation, the mortality risk was increased 7-fold for both men and women. Mortality risk was not raised above that of the background population for elective groin hernia repair, but it was increased 7-fold after emergency operations and 20-fold if bowel resection was undertaken. Overall SMR was 1.4 (95% confidence interval, 1.2–1.6) for men and 4.2 (95% confidence interval, 3.2–5.4) for women, in accordance with a greater proportion of emergency operations among women compared with men, 17.0%, versus 5.1%.

Conclusions: Mortality risk following elective hernia repair is low, even at high age. An emergency operation for groin hernia carries a substantial mortality risk. After groin hernia repair, women have a higher mortality risk than men due to a greater risk for emergency procedure irrespective of hernia anatomy and a greater proportion of femoral hernia.

Mortality of patients having elective hernia repair is not raised above that of the general population, whereas emergency repair is associated with considerable mortality. Postoperative mortality is higher for women than for men because of a higher incidence of femoral hernia and a greater overall risk for emergency surgery.

From the *Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; †Department of Surgery, Umeå University Hospital, Umeå, Sweden; and ‡Department of Surgery, Östersund Hospital, Östersund, Sweden.

The Swedish Hernia Register is financially supported by the National Board of Health and Welfare and by the Swedish Association of Local Authorities.

Surgical units participating in SHR are described in:

Reprints: Erik Nilsson, MD, PhD, Department of Surgery, Umeå University Hospital, SE90185 Umeå, Sweden. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.