M. H. Zeb1, M. M. El Khatib1, A. Chandra1, T. Pandian1, N. D. Naik1, D. S. Morris2, R. L. Smoot1, D. R. Farley1 1Mayo Clinic,Division Of Subspecialty General Surgery,Rochester, MN, USA 2Mayo Clinic,Division Of Trauma Critical Care & General Surgery,Rochester, MN, USA
Introduction:
Groin hematoma following inguinal herniorrhaphy (IHR) is an infrequent complication that can cause significant patient discomfort, require reoperation, and delay postoperative recovery. While we reported a decade ago on potential predictors for groin hematoma, we sensed an increase recently in the hematoma frequency in our practice. We aimed to reassess our experience with groin hematoma following IHR and provide a more updated assessment of the risk factors inherent to this complication.
Methods:
We retrospectively identified all adult patients (age ≥18 years) who developed groin hematoma following IHR at our institution between the years 2003-2015. Patients were matched to age and gender controls in a 1:1 ratio. Patient characteristics and operative details were extracted from the medical record. Univariate analyses (using Pearson’s chi-square test) were performed to assess for differences in baseline characteristics (BMI, medications, medical history, hernia operative technique). A p value ≤0.05 was considered statistically significant. A multivariable model was then constructed in stepwise fashion to assess for independent predictors of groin hematoma.
Results:
From 6608 inguinal hernia repairs, 96 patients developed a groin hematoma. The hematoma frequency increased from our previous study (1.4 % vs. 0.9%, p<0.01). Mean age in this cohort was 64.6 years (range: 18-92) and 84.3% were male. 48% of cases developed the hematoma within 48 hours of surgery. There was no significant difference in the location (left, right, bilateral), type (direct, indirect, pantaloon, first repair, or recurrent), or technique of hernia repair (Bassini, Lichtenstein, mesh plug, laparoscopic, or McVay) between study and control groups. Univariate analysis identified warfarin usage (OR 3.5, 95% CI [1.6, 6.4], p<0.01), valvular disease (OR 11.6, 95% CI [2.6,51.3], p<0.01), atrial fibrillation (OR 2.6, 95% CI [1.2,5.5], p=0.01), hypertension ( OR 2.03, 95% CI [1.1, 3.6], p=0.02), recurrent hernia (OR 3.7, 95% CI [1.4, 9.7], p<0.01), and coronary artery disease (OR 2.1, 95% CI [1.0, 4.4 ], p=0.05) as significant preoperative factors. The proportion of patients with warfarin usage decreased since our prior report (31% vs. 42%, p=0.2). On multivariable regression, warfarin usage and recurrent hernia were independent predictors of groin hematoma development.
Conclusion:
Groin hematoma after IHR has increased in frequency over the last decade at our institution. In our cohort, independent risk factors for the development of groin hematoma included warfarin use and recurrent hernia. Patients on warfarin therapy before elective IHR should be thoroughly assessed for appropriate cessation and resumption of anticoagulation prior to surgery. Surgical hypervigilance and meticulous hemostasis remains prudent in all patients undergoing IHR and especially those with recurrent inguinal hernia.