Recurrence of Inguinal Hernias Repaired in a Large Hernia Surgical Specialty Hospital and General Hospitals in Ontario, Canada

Overview

Journal Can J Surg

Specialty General Surgery

Date 2015 Nov 18

PMID 26574701

Citations 33

Authors

Atiqa Malik

Chaim M Bell

Therese A Stukel

David R Urbach

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

The learning curve for the Shouldice Repair: a pilot analysis of post-training specialized surgeons at the Shouldice Hospital.

Paasch C, Hunger R, Szasz P, Yilbas A, Netto F, Mantke R Hernia. 2025; 29(1):70.

PMID: 39847122 PMC: 11757887. DOI: 10.1007/s10029-024-03252-0.

Polypropylene vs. stainless-steel wire suture: short-term recurrence rate after shouldice primary inguinal hernia repair, a non-inferior analysis among 1120 patients. A case-control study.

Paasch C, Mainprize M, Hunger R, Netto F Hernia. 2024; 28(6):2177-2186.

PMID: 39210196 PMC: 11530496. DOI: 10.1007/s10029-024-03110-z.

The Impact of a Specialized Hernia Center and Standardized Practices on Surgical Outcomes in Hernia Surgery: A Systematic Review and Meta-Analysis.

da Silveira C, Dias Rasador A, Lima D, Nogueira R, Sanha V, Kasakewitch J J Abdom Wall Surg. 2024; 3:13270.

PMID: 39104598 PMC: 11298397. DOI: 10.3389/jaws.2024.13270.

How to Article: Prehabilitation and postoperative treatment at Shouldice Hospital.

Mainprize M, Paasch C, Netto F Ann Med Surg (Lond). 2024; 86(3):1818-1820.

PMID: 38463062 PMC: 10923371. DOI: 10.1097/MS9.0000000000001815.

Open preperitoneal inguinal hernia repair has superior 1-year patient-reported outcomes compared to Shouldice non-mesh repair.

Bharani T, Agarwal D, Fullington N, Ott L, Olson M, McClain D Hernia. 2023; 28(2):475-484.

PMID: 38142262 DOI: 10.1007/s10029-023-02936-3.

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