The Management of Inguinal Hernia Repair During the Covid-19 Pandemic — A Nationwide, Retrospective Cohort Study From Swedish Hernia Register

Aim Inguinal hernia repair (IHR) in Sweden is mainly performed in elective daycare setting. As the COVID-19 spread rapidly and caused global pandemic in 2020, the Swedish healthcare initially postponed all elective surgeries to reallocate their sources. Our aim is to investigate the impact of COVID-pandemic on IHRs and the clinical outcomes in short- and long-term. Methods Retrospective cohort study from Swedish Hernia Register (SHR) on data from 109 656 inguinal hernia repairs between 2015–2021 to compare the quality of IHRs before and during the pandemic. The results are presented according to STROBE checklist after using multivariate logistic regression analysis to calculate the complication risks. Results In 2020, inguinal hernia repairs reduced by 22,3%, going from 16321 repairs/year to 12686 repairs. Notably, the percentage of acute IHRs increased from 4,8% to 5,7% as the elective surgery decreased. The risk for emergent IHR was higher for patients >70 years (OR 4:53, p = 0.039) and ASA score >3 (p < 0.001), and highly associated with severe postoperative complications (Clavien-Dindo 3b-5) within 30 days (OR 3,85, p <0.001). The 30-day mortality and recurrence rates did not differ between the groups. Conclusions We noticed a slightly increased number of acute IHRs for older patients with higher comorbidity during the initial phase of pandemic. Despite that, the presumed level of IHRs was reached by the end of 2021 without increased overall complication rates.