A 19 year population based cohort study analysing reoperation for recurrence following laparoscopic and open inguinal hernia repairs

George Ramsay*, Neil W. Scott, Jan Jansen

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Introduction Laparoscopic (LHR) and open (OHR) inguinal hernia repairs are both used to treat primary herniae. This study analyses the rates of operation for recurrence after laparoscopic and open inguinal hernia repair, at a population level, while considering competing risks, such as death and other operative interventions. Methods This is a population cohort study in Scotland. All adult patients who had a primary inguinal hernia repair in Scotland between 01/04/1996 and 01/01/2015 were included. The main outcome was recurrent operations. Cumulative incidence functions (CIF) were calculated for competing risks of death. A cox proportional hazards regression model was used to control for confounders of age, gender, bilateral herniae, deprivation and year of procedure. Results Of 88,590 patients, there were 10,145 LHR and 78,445 OHR. Recurrent operations were required in 1397 (1.8%) OHR and 362 (3.6%). LHR had greater hazard of recurrence than OHR (HR 1.83, 95% CI 1.61-2.08, p <0.001). Faster time to recurrence was also associated with being older (HR for one year increase: 1.010, 95% CI 1.007-1.013, p <0.001), being more affluent (HR 1.18, 95% CI 1.01-1.38, p = 0.04) and having a bilateral index operation (HR 2.53, 95% CI 2.22-2.88, p <0.001). Conclusions LHR is becoming more popular in Scotland over the past 2 decades. However, when other key confounding factors are controlled, it is associated with a higher recurrence rate.

Original languageEnglish
JournalHernia
Early online date30 Nov 2019
DOIs
Publication statusE-pub ahead of print - 30 Nov 2019

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Inguinal Hernia
Herniorrhaphy
Reoperation
Scotland
Cohort Studies
Recurrence
Hernia
Population
Proportional Hazards Models
Incidence

Keywords

  • OPEN MESH REPAIR
  • COMPETING RISK ANALYSIS
  • CHRONIC PAIN
  • METAANALYSIS
  • TRIAL
  • LICHTENSTEIN

Cite this

@article{67d132bc1ab647deb3440954fb3487ab,
title = "A 19 year population based cohort study analysing reoperation for recurrence following laparoscopic and open inguinal hernia repairs",
abstract = "Introduction Laparoscopic (LHR) and open (OHR) inguinal hernia repairs are both used to treat primary herniae. This study analyses the rates of operation for recurrence after laparoscopic and open inguinal hernia repair, at a population level, while considering competing risks, such as death and other operative interventions. Methods This is a population cohort study in Scotland. All adult patients who had a primary inguinal hernia repair in Scotland between 01/04/1996 and 01/01/2015 were included. The main outcome was recurrent operations. Cumulative incidence functions (CIF) were calculated for competing risks of death. A cox proportional hazards regression model was used to control for confounders of age, gender, bilateral herniae, deprivation and year of procedure. Results Of 88,590 patients, there were 10,145 LHR and 78,445 OHR. Recurrent operations were required in 1397 (1.8{\%}) OHR and 362 (3.6{\%}). LHR had greater hazard of recurrence than OHR (HR 1.83, 95{\%} CI 1.61-2.08, p <0.001). Faster time to recurrence was also associated with being older (HR for one year increase: 1.010, 95{\%} CI 1.007-1.013, p <0.001), being more affluent (HR 1.18, 95{\%} CI 1.01-1.38, p = 0.04) and having a bilateral index operation (HR 2.53, 95{\%} CI 2.22-2.88, p <0.001). Conclusions LHR is becoming more popular in Scotland over the past 2 decades. However, when other key confounding factors are controlled, it is associated with a higher recurrence rate.",
keywords = "OPEN MESH REPAIR, COMPETING RISK ANALYSIS, CHRONIC PAIN, METAANALYSIS, TRIAL, LICHTENSTEIN",
author = "George Ramsay and Scott, {Neil W.} and Jan Jansen",
note = "Open Access via Springer Compact Agreement.",
year = "2019",
month = "11",
day = "30",
doi = "10.1007/s10029-019-02073-w",
language = "English",
journal = "Hernia",
issn = "1265-4906",
publisher = "Springer Paris",

}

TY - JOUR

T1 - A 19 year population based cohort study analysing reoperation for recurrence following laparoscopic and open inguinal hernia repairs

AU - Ramsay, George

AU - Scott, Neil W.

AU - Jansen, Jan

N1 - Open Access via Springer Compact Agreement.

PY - 2019/11/30

Y1 - 2019/11/30

N2 - Introduction Laparoscopic (LHR) and open (OHR) inguinal hernia repairs are both used to treat primary herniae. This study analyses the rates of operation for recurrence after laparoscopic and open inguinal hernia repair, at a population level, while considering competing risks, such as death and other operative interventions. Methods This is a population cohort study in Scotland. All adult patients who had a primary inguinal hernia repair in Scotland between 01/04/1996 and 01/01/2015 were included. The main outcome was recurrent operations. Cumulative incidence functions (CIF) were calculated for competing risks of death. A cox proportional hazards regression model was used to control for confounders of age, gender, bilateral herniae, deprivation and year of procedure. Results Of 88,590 patients, there were 10,145 LHR and 78,445 OHR. Recurrent operations were required in 1397 (1.8%) OHR and 362 (3.6%). LHR had greater hazard of recurrence than OHR (HR 1.83, 95% CI 1.61-2.08, p <0.001). Faster time to recurrence was also associated with being older (HR for one year increase: 1.010, 95% CI 1.007-1.013, p <0.001), being more affluent (HR 1.18, 95% CI 1.01-1.38, p = 0.04) and having a bilateral index operation (HR 2.53, 95% CI 2.22-2.88, p <0.001). Conclusions LHR is becoming more popular in Scotland over the past 2 decades. However, when other key confounding factors are controlled, it is associated with a higher recurrence rate.

AB - Introduction Laparoscopic (LHR) and open (OHR) inguinal hernia repairs are both used to treat primary herniae. This study analyses the rates of operation for recurrence after laparoscopic and open inguinal hernia repair, at a population level, while considering competing risks, such as death and other operative interventions. Methods This is a population cohort study in Scotland. All adult patients who had a primary inguinal hernia repair in Scotland between 01/04/1996 and 01/01/2015 were included. The main outcome was recurrent operations. Cumulative incidence functions (CIF) were calculated for competing risks of death. A cox proportional hazards regression model was used to control for confounders of age, gender, bilateral herniae, deprivation and year of procedure. Results Of 88,590 patients, there were 10,145 LHR and 78,445 OHR. Recurrent operations were required in 1397 (1.8%) OHR and 362 (3.6%). LHR had greater hazard of recurrence than OHR (HR 1.83, 95% CI 1.61-2.08, p <0.001). Faster time to recurrence was also associated with being older (HR for one year increase: 1.010, 95% CI 1.007-1.013, p <0.001), being more affluent (HR 1.18, 95% CI 1.01-1.38, p = 0.04) and having a bilateral index operation (HR 2.53, 95% CI 2.22-2.88, p <0.001). Conclusions LHR is becoming more popular in Scotland over the past 2 decades. However, when other key confounding factors are controlled, it is associated with a higher recurrence rate.

KW - OPEN MESH REPAIR

KW - COMPETING RISK ANALYSIS

KW - CHRONIC PAIN

KW - METAANALYSIS

KW - TRIAL

KW - LICHTENSTEIN

U2 - 10.1007/s10029-019-02073-w

DO - 10.1007/s10029-019-02073-w

M3 - Article

JO - Hernia

JF - Hernia

SN - 1265-4906

ER -