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Commentary: Nationwide analysis of complications related to inguinal hernia surgery in Finland: a 5 year register study of 55,000 operations

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Abstract

Background

The aim of this study was to evaluate the incidence of severe complications of adult inguinal hernia surgery from 2003 to 2007 using data from the Finnish National Patient Insurance Association.

Methods

All major surgical complications are reported to the association because it handles financial compensation for patients' injuries without proof of malpractice. The number of inguinal hernioplasties was obtained from the National Hospital Discharge Registry.

Results

The association received reports of 115 major and 135 moderate complications from 55,000 hernia operations. The overall complication rate was 4.5 per 1,000 hernia procedures. The distribution of injuries consisted of chronic pain (32%), infections (22%), bleeding complications (13%), urologic complications (12%), recurrence (8%), intestinal complications (7%), and miscellaneous disorders (6%). Altogether, 94 patients (38%) received financial compensation from their hospitals. On multivariate analysis, significant associations with chronic pain were found for general anesthesia, length of operation, and the presence of wound complications.

Conclusions

Chronic inguinal pain and deep infections were associated with severe long-term discomfort and financial compensation to patients with inguinal hernias in Finland.

Section snippets

Methods

The retrospective material consisted of 250 complications reported to the National Patient Insurance Association from January 2003 to December 2007. All complications occurring during open or laparoscopic repair of inguinal or femoral hernias in adult patients were included in the analysis. Complications were divided into moderate (n = 135) and major (unreasonable) (n = 115) complications. Indications for surgery in complicated cases were inguinal hernia (n = 196), inguinal pain (n = 23),

Results

From 2003 through 2007, some 55,000 inguinal hernioplasties were carried out at communal and private hospitals in Finland (Table 1). Most procedures (>80%) were performed using an open mesh technique. The number of laparoscopic and femoral hernia repairs remained rather stable. During the 5-year study period, 250 complications were reported to the National Patient Insurance Association. Chronic pain and wound complications accounted for more than two thirds of all reported side effects of

Comments

Our registry-based study indicated that inguinal hernia repair is seldom associated with severe postoperative complications and patient discomfort. The reported failure rate was only 4.5 per 1,000 inguinal operations. Most complications were related to the repair of primary hernias, to nonemergency operations, and to the use of the open technique. This is in line with the frequency and types of hernia procedures performed annually in Finland. If the total amount of operations was included in

Acknowledgments

The technical assistance of Mrs Saija Lehtinen and Mrs Pirjo Halonen (biostatistical analysis) is greatly acknowledged. We thank Mrs Lisa Kivela for revising the English. The experiments comply with the current laws of Finland.

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