Where is the nerve? Review of operation note documentation practice for inguinal hernia repair

Abstract

Introduction Careful identification and management of inguinal nerves during inguinal hernia repair is important to avoid iatrogenic injury. Documentation of this practice may inform postoperative clinical management. We set out to investigate how often surgeons identify inguinal nerves and document findings and management in their operation notes. Methods We carried out a retrospective review of operation notes at a single district general hospital. We analysed operation notes for documentation of identification and intraoperative management (preservation or sacrifice) of the inguinal nerves (iliohypogastric, ilioinguinal, genital branch of genitofemoral nerve). We collected data on the baseline characteristics of the patients, hernia characteristics and primary operating surgeons for subgroup analysis. Results A total of 100 patients were included in the analysis. Identification of any inguinal nerves (generic ‘nerve’) was documented in 17% of operation notes. Documentation in the operation notes of named individual nerves was limited. No documentation of intraoperative management of inguinal nerves was found in 83% of operation notes. Preservation of the inguinal nerves (generic ‘nerve’) was recorded in 8% and sacrifice recorded in 9% of cases. Subgroup analysis revealed similar incidence of documentation of identification and management of inguinal nerves across grades of primary surgeon, with overall incidence low for all grades. Conclusion This study reveals a lack of appreciation of the importance of documenting identification and management of inguinal nerves in operation notes. Further consideration of the potential implications of poor documentation would be beneficial to improve standards.

Nerve identification during open inguinal hernia repair: a systematic review and meta-analyses

“…Table 2 displays the results of the bias assessment of the observational studies using the JBI critical appraisal tool. Overall, four studies [ 6 , 22 , 26 , 27 ] had a moderate risk of bias in question 4, because it was unclear whether nerves were identified according to common practice. These studies were excluded from the sensitivity analyses, which excluded studies with a moderate to high risk of bias.…”

“…Regarding the response rate, Smeds et al [ 6 ] had a response rate of 55% and did not account for non-responders at follow-up, but we assessed that this would not skew identification rates. Similarly, Farquharson et al [ 22 ] noted that the majority of medical journal notes from which data were sampled did not mention any nerves, and was therefore excluded from the meta-analyses.…”

“…Similarly, Farquharson et al [ 22 ] noted that the majority of medical journal notes from which data were sampled did not mention any nerves, and was therefore excluded from the meta-analyses.…”