Incidence and predictors of early complications following ambulatory inguinal hernia repairs at Mulago national referral hospital: A prospective cohort study.

Abstract

ABSTRACT Background: Ambulatory inguinal hernia repair is increasingly adopted worldwide due to its safety, cost-effectiveness, and potential to reduce surgical backlogs. However, data on postoperative outcomes in low-resource settings remains limited. This study assessed the incidence and predictors of early postoperative complications following ambulatory inguinal hernia repair at Mulago National Referral Hospital. Objective: To determine the incidence and predictors of early complications following ambulatory inguinal hernia surgeries at MNRH, Uganda. Methods: A prospective cohort study was conducted among adult patients undergoing ambulatory inguinal hernia repair. Consecutive eligible patients were enrolled and followed for seven days postoperatively. Baseline demographic and clinical characteristics, perioperative variables, and early postoperative complications were captured using a structured data tool. Logistic regression analysis was used to identify predictors of early complications, with statistical significance set at p<0.05. Results: Over a four month period, a total of 132 participants were enrolled, with males comprising most of the cohort (83.3%). The median age was 31 years (IQR: 12 years). Local anesthesia was used in all cases; Mesh repair was done for 4/132 (3%) while tissue repair was done for 128/132 (97%) patients. All repairs were done by senior house officers. Follow up period was seven days. The overall incidence of early postoperative complications was 6.8% (95% CI: 3.2%–12.6%). Postoperative nausea was the most frequent complication, 3% (4), followed by bleeding/hematoma,1.5% (2) moderate pain,0.8% (1) surgical site infection, 0.8% (1) and urinary retention, 0.8% (1). Other complications reported included, dizziness and numbness of the limbs especially on the side of repair. There were no mortalities. On multivariate analysis, prolonged duration of surgery was the main predictor of early complications (adjusted OR: 3.77; 95% CI: 1.21–11.71; p=0.022). Other variables for instance; age, sex, and ASA classification showed positive but non-significant associations with early postoperative complications. Conclusion: Ambulatory inguinal hernia repair had a low early complication rate of 6.8%, in a relatively young and healthy population, postoperative nausea was the most frequently encountered complication at an incidence rate of 3% and prolonged duration of surgery (> 50 minutes) was identified as the main predictor of early postoperative complications. These findings support its wider adoption in low resource settings.