Objective: To establish a register of inguinal hernia surgery that all
ows audit and analyses of data from several centres. Design: Prospecti
ve recording of data on a common protocol. Setting: Eight Swedish hosp
itals. Subjects: All groin hernia operations done for patients over 15
years old from January 1992 to December 1994. Main outcome measures:
Methods of repair, postoperative complications including mortality, da
y surgery rate, and reoperations for recurrence. Results: During the t
hree years studied 4879 hernia operations were undertaken in 4474 pati
ents. Postoperative mortality within 30 days of operation for emergenc
y and elective hernia repairs was 3.5% and 0.07%, respectively. Of all
herniorrhaphies 798 (16%) were done for recurrences, 142 of these aft
er operations between 1992 and 1994. At 24 months 4% of all operations
had been redone because of recurrences with highly significant variat
ions among hospitals ranging from 1.5% to 6.7%. Postoperative complica
tions within 30 days after operation, direct hernia, recurrent hernia,
and the use of absorbable sutures were associated with an increased r
isk of reoperation. Conclusions: A quality register recorded voluntari
ly can identify significant interhospital differences in outcome as we
ll as variables associated with an increased risk of reoperation, ther
eby raising quality awareness and facilitating the process of improvem
ent.