Recurrence of inguinal hernias repaired in a large hernia surgical specialty hospital and general hospitals in Ontario, Canada

• Published in: Canadian Journal of Surgery Vol. 59; no. 1; pp. 19 - 25
• Main Authors: Malik, Atiqa, MSc, Urbach, David R., MD, MSc, Stukel, Thérèse A., PhD, Bell, Chaim M., MD, PhD
• Format: Journal Article
• Language: English
• Published: Canada Joule Inc 01.02.2016; CMA Impact, Inc; 8872147 Canada Inc
• Subjects: Care and treatment; Diseases; Female; Hernia; Hernia, Inguinal - surgery; Hernias; Hospitals; Hospitals, General - statistics & numerical data; Hospitals, Special - statistics & numerical data; Humans; Inguinal hernia; Male; Medical treatment; Middle Aged; Ontario; Outcome Assessment (Health Care) - statistics & numerical data; Patient outcomes; Recurrence; Relapse; Reoperation - statistics & numerical data; Surgery; Surgical outcomes; Surgicenters - statistics & numerical data; Ontario; Canada; Ontario Canada
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.003915

Background The effect of hospital specialization on the risk of hernia recurrence after inguinal hernia repair is not well described. Methods We studied Ontario residents who had primary elective inguinal hernia repair at an Ontario hospital between 1993 and 2007 using population-based, administrative health data. We compared patients from a large hernia specialty hospital (Shouldice Hospital) with those from general hospitals to determine the risk of recurrence. Results We studied 235 192 patients, 27.7% of whom had surgery at Shouldice hospital. The age-standardized proportion of patients who had a recurrence ranged from 5.21% (95% confidence interval [CI] 4.94%–5.49%) among patients who had surgery at the lowest volume general hospitals to 4.79% (95% CI 4.54%–5.04%) who had surgery at the highest volume general hospitals. In contrast, patients who had surgery at the Shouldice Hospital had an age-standardized recurrence risk of 1.15% (95% CI 1.05%–1.25%). Compared with patients who had surgery at the lowest volume hospitals, hernia recurrence among those treated at the Shouldice Hospital was significantly lower after adjustment for the effects of age, sex, comorbidity and income level (adjusted hazard ratio 0.21, 95% CI 0.19–0.23, p < 0.001). Conclusion Inguinal hernia repair at Shouldice Hospital was associated with a significantly lower risk of subsequent surgery for recurrence than repair at a general hospital. While specialty hospitals may have better outcomes for treatment of common surgical conditions than general hospitals, these benefits must be weighed against potential negative impacts on clinical care and the financial sustainability of general hospitals.