International snapshot study exploring the impact of COVID-19 on elective inguinal hernia repair

Fleming, Christina; Croghan, Stefanie; Elliot, Jessie A; Mohan, Helen; Boland, M; Bolger, Jarlath; O’Neill, Áine; Fullard, Anna; Creavin, Ben; Murphy, Brenda; Cullinane, Carolyn; Hayes, Cathal; Clancy, Cillian; Neary, Colm; Kennedy, C. M.; Harji, Deena; Manatakis, Dimitrios K.; Ryan, Éanna J; Hannon, E. E.; Burke, Eoghan; Pata, Francesco; McDermott, Frank; Gallo, Gaetano; Pellino, Gianluca; Early, Helen; Reynolds, Ian S.; Ryan, Jessica; Mendes, J.; Clements, Joshua; Ng, Kin Cheung; Akmenkalne, Liga; Aljohmani, Lylas; Davey, Matthew G; Alqassab, Mohammed; Navidad, Monica Serrano; Hardy, Niall; McInerney, Niall; Foley, Niamh; Tasis, Nikolaos; Donlon, Noel E; Boland, Patrick A; Jordan, Patrick; Lonergan, Peter E.; Stevens, Sean; O’Brien, Stephen; Murphy, Suzanne; Barnes, Tracey

doi:10.1093/bjs/znab198

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…A minimally invasive surgical approach accounted for 17.8% of IHR in this global cohort, which is similar to the 13% to 18% rate reported by international surgeons in an earlier snapshot study by the RETAINER Collaborative Group, Irish Surgical Research Collaborative . It is possible that the early stage of the COVID-19 pandemic was associated with some practice shifts toward open surgery and local and regional anesthesia and with a slightly lower minimally invasive surgical rate than might have been encountered at another time.…”

Section: Discussionsupporting

confidence: 74%

“…The first wave of the SARS-CoV-2 pandemic in 2020 severely affected health care systems immediately prior to the intended launch of RETAINER I, with IHR deprioritized in many centers . Accordingly, 2 postponements of the launch date occurred until March 2021, and a pragmatic approach was applied, with site leaders permitted to select the most feasible data collection block (minimum, 4 weeks; aim, 12 weeks) for their center over a 6-month period.…”

Section: Methodsmentioning

confidence: 99%

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Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

et al. 2023

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ImportancePostoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.ObjectiveTo ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and ParticipantsThe Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.ExposureOpen or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and MeasuresThe primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.ResultsIn total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).ConclusionsThe findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies.

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Section: Discussionsupporting

confidence: 74%

Section: Methodsmentioning

confidence: 99%

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

et al. 2023

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“…6 Moreover, a baseline decrease was reported in the elective scheduled surgeries in early 2020 as the result of governmental counteracts, 7 also with a consequent modification of the selection criteria of patients on the waiting list. 8 On the other hand, a steady curve before and during the pandemic regarding the number of urgent hernioplasty has been also reported. 9 Lastly, some authors suggested that in mildly symptomatic patients a safe management of the waiting list was obtained through the assessment of analgesic consumption and anamnestic frailty.…”

Section: Discussionmentioning

confidence: 99%

The unexpected social cost of inguinal hernioplasty procedures derived from the COVID‐19 pandemic: Surgical trend analysis based on an Italian hospital series

De Luca,

Gurrado,

Prete

et al. 2024

World j. surg.

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BackgroundThe majority of inguinal hernias are usually paucisymptomatic, so are restored electively. The main purpose of this study is to assess the trends in hernia repair surgery before and during the pandemic period, analyzing an Italian hospital series of 390 patients, in an attempt to quantify the negative impact regarding social costs derived from the Covid‐19 outbreak. Moreover, we want to focus on the concept of apparently minor pathology as hernioplasty which could represent a life‐threatening condition for patients.MethodsThe study population consisted of all patients operated for inguinal hernia in a General Surgery Unit from 2019 to 2021, divided into a pre‐pandemic and a pandemic period.ResultsThe Covid‐19 pandemic increased urgent operations in a complicated setting. A statistically significant difference was found regarding the trend of hospitalization length as well as a strong positive correlation between the severity of hernia and the hospitalization length.ConclusionsDuring the pandemic, it has been registered a mishandling of inguinal hernias to the detriment of both the healthcare system and patients, due to multifactorial issues and, in particular, to the restrictions imposed by the regional government that erroneously declassed hernia pathology as a minor problem for public health. We do believe that patients, after diagnosis of inguinal hernia, should learn the Taxis maneuver for its feasibility and ease of execution, in order to reduce access to emergencies in many cases and likewise to better pain and discomfort perceived, even in the event of unexpected worldwide healthcare scenario.

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“…One possible explanation for this result is the different type of mesh material used as a shift from polyester to propylene was seen. Although most articles in the literature do not associate polypropylene mesh material with the increased risk of seroma formation [15,16], and this result must be investigated in future studies.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on clinical outcomes of robotic inguinal hernia repair

Kudsi

Kaoukabani

Friedman

et al. 2023

Hernia

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Purpose To investigate the impact of the COVID-19 pandemic on the clinical impact of the clinical outcomes of robotic inguinal hernia repair. Methods Patients who underwent RIHR 2 years before and after March 10, 2020, were included in this retrospective study and assigned accordingly to the pre- or post-COVID group. Pre-, intra-, and postoperative variables including patients’ demographics, hernia characteristics, complications, and hernia recurrence rates were compared between groups. Results 183 (94.5% male) and 141 (96.4% male) patients were assigned to the pre- and post-COVID groups, respectively. Patient demographics and medical comorbidities did not differ between groups. Operative time was approximately 40 min longer in the post-COVID group ( p < 0.001) with higher rates of bilateral IHR (pre-COVID: 30.1% vs. post-COVID: 46.4%, p = 0.003). Mesh material differed between groups with predominance of polyester mesh in the pre-COVID group vs. polypropylene in the post-COVID one. Median hospital length of stay (LOS) was 0 days in both groups, and same-day discharge rates were 93.4% pre-pandemic and 92.8% post-pandemic ( p = 0.09). There were no pulmonary complications recorded in either group or no cases of COVID-19 detected within two weeks postoperatively in the post-COVID group. Seromas were more frequent in the post-COVID group (pre-COVID: 2 vs. post-COVID: 8, p = 0.018) and no hernia recurrences were recorded. Conclusion This is the first study to describe the impact of COVID-19 on RIHR. Clinical outcomes and hernia-specific complications were not impacted by the COVID-19 pandemic.

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International snapshot study exploring the impact of COVID-19 on elective inguinal hernia repair

Abstract: The RETAINER Collaborative Group reports the impact of COVID-19 on international elective inguinal hernia practice.

Cited by 8 publications

References 4 publications

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

The unexpected social cost of inguinal hernioplasty procedures derived from the COVID‐19 pandemic: Surgical trend analysis based on an Italian hospital series

Impact of COVID-19 on clinical outcomes of robotic inguinal hernia repair

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