Deaths following hernia surgery: room for improvement

Background: Abdominal wall herniae are common and may well lead to death. T he aim of this study was to examine the deaths of patients with an inguinal , femoral or incisional hernia to identify aspects of management which coul d be improved upon. Method: Data collected by the Scottish Audit of Surgica l Mortality 1994-1997 was analysed by interrogation of the database for all deaths on a surgical ward or within 30 days of surgery where the principle diagnosis was inguinal, fermoral or incisional hernia. Results: There were 133 deaths out of 31,525 operations over the 4-year period. Mortality was highest among femoral hernia operations in women (37 deaths/1184 operations ; 3.1%) and 59% of femoral hernia surgery was performed outwith normal work ing hours. The 133 patients were elderly (mean age 79 years) and unfit, but less than half the operations involved consultant anaesthetists or consult ant surgeons. Delay in referral contributed to death in 15/133 patients and adverse factors in management, particularly in the perioperative period, c aused the death of 2 patients and contributed to the death of a further 29/ 133. Conclusions: Herniae carry a significant mortality in elderly, unfit p atients who require close attention to perioperative management. These pati ents should be anaesthetised and operated upon by consultant staff during t he normal working day.