REOPERATION AS SURROGATE END-POINT IN HERNIA SURGERY - A 3 YEAR FOLLOW-UP OF 1565 HERNIORRHAPHIES

Objective: Analysis of reoperation and recurrence rates three years af ter repair of groin hernias. Design: Prospective audit by questionnair e and selective follow-up. Setting: Eight Swedish hospitals. Subjects: All groin hernia operations done during 1992 on patients between the ages of 15 and 80 years. Main outcome measures: Postoperative complica tions, reoperation for recurrence, and recurrence. Results: During 199 2, 1565 hernia operations were done. The postoperative complication ra te was 8% (125/1565). At 36 months postoperatively 108 recurrences had already been reoperated on, six patients with recurrences were on the waiting List for reoperation and a further 36 recurrences had been de tected at follow-up. The interhospital variation in recurrence rate ra nged from 3% to 20%. Postoperative complications, recurrent hernia, di rect hernia and hospital catchment area over 100000 inhabitants were a ll factors associated with an increased relative risk of recurrence. C onclusions: The recurrence rate exceeded the reoperation rate for recu rrence by almost 40% which should be taken into account if the reopera tion rate is used as the endpoint after repairs of groin hernia. An au dit scheme, based on prospective recording, reoperation rate, and (per iodic) calculation of the recurrence rate may be used to identify risk factors for recurrence and areas in need of improvement.