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

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. Contexte L'effet de la specialisation des hopitaux sur le risque de recurrence de la hernie inguinale apres sa reparation n'a pas ete bien decrit. Methodes partir des donnees administratives de sante de la population, nous avons etudie des patients ontariens ayant subi une reparation de hernie inguinale primaire non urgente dans un hopital de l'Ontario entre 1993 et 2007. Nous avons compare les patients operes dans un grand hopital specialise pour les hernies (Hopital Shouldice) aux patients operes dans les hopitaux generaux afin de determiner le risque de recurrence. Resultats Nous avons ainsi etudie 235 192 patients, dont 27,7 % ont subi leur intervention chirurgicale a l'Hopital Shouldice. La proportion standardisee selon l'age de patients ayant eu une recurrence a varie de 5,21 % (intervalle de confiance [IC] de 95 % 4,94 %-5,49 %) chez les patients ayant subi l'intervention dans les hopitaux generaux oU le volume est moindre, a 4,79 % (IC de 95 % 4,54 %-5,04 %) qui ont subi leur intervention dans les hopitaux generaux oU le volume est plus eleve. En revanche, les patients qui ont subi leur intervention chirurgicale a l'Hopital Shouldice ont presente un risque de recurrence standardise selon l'age de 1,15 % (IC de 95 % 1,05 %-1,25 %). Comparativement aux patients ayant subi leur intervention dans les hopitaux oU le volume est moindre, la recurrence de la hernie chez les patients traites a l'Hopital Shouldice a ete considerablement moindre apres ajustement pour tenir compte des effets de l'age, du sexe, des comorbidites et du niveau de revenu (risque relatif ajuste 0,21, IC de 95 % 0,19-0,23, p < 0,001). Conclusion La reparation des hernies inguinales a l'Hopital Shouldice a ete associee a un risque bien moindre d'intervention chirurgicale subsequente pour recurrence comparativement a la reparation effectuee dans un hopital general. Les hopitaux specialises peuvent avoir de meilleurs resultats lors du traitement des problemes chirurgicaux courants comparativement aux hopitaux generaux, mais ces avantages doivent etre soupeses en tenant compte des impacts negatifs potentiels sur les soins cliniques et la viabilite financiere des hopitaux generaux.