Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study

Background Groin hernia repair is one of the most frequent operations, but there is no consensus about surgical or anaesthetic technique. Furthermore, no nationwide studies have been done. Our aim was to investigate outcome r esults of groin hernia surgery to improve quality of treatment. Methods We prospectively recorded 26 304 groin hernia repairs done in Denma rk from Jan 1, 1998, to June 30, 2000, in a nationwide Danish hernia databa se. Findings 93% of all groin herniorrhaphies done in Denmark in the 30 months of the study were recorded in the database. Kaplan-Meier estimates of reope ration rates 30 months after anterior mesh repair and laparoscopic repair w ere significantly lower than after sutured posterior wall repairs in primar y inguinal hernia (2.2% and 2.6% vs 4.4%; p < 0.0001). Reoperation rates we re also lower with anterior mesh repair (6.1%; p < 0.0001) and laparoscopic repair (3.4%; p < 0.0001) than with sutured posterior wall repair (10.6%) after recurrent hernia. Use of Lichtenstein mesh repair increased from 33% in January, 1998, to 62% in June, 2000, whereas use of laparoscopic repair remained constant at about 5%. Kaplan-Meier estimates of reoperation rates were 2.8% in the first 15 months and 1.6% in the second (p = 0.03). For ele ctive repairs, only 59% of patients were treated on an outpatient basis, an d only 18% had local anaesthesia. Interpretation Mesh repairs have a lower reoperation rate than conventional open repairs. Systematic prospective recording of treatment and outcome va riables in a national clinical database improved the overall quality of sur gical care. However, there is a large potential for cost savings and more e fficient patient care with extended use of mesh techniques, outpatient surg ery, and local anaesthesia.