Management of Acutely Symptomatic Hernia

Study Overview
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Brief Summary
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Acutely symptomatic abdominal wall hernia can cause many symptoms and complications. They can be associated with levels of morbidity beyond that seen in emergency laparotomy. There is limited data to guide practice in this field. This observational cohort study will explore variation in practice around assessment, repair and outcomes of hernias treated in the emergency setting.

Detailed Description
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There are many different types of hernia, with the most common being in the groin or at the umbilicus. Hernias affect a significant proportion of the population and can vary from producing no symptoms at all, to causing a blockage to the bowel that requires urgent surgery. Hernias affect people of all ages and degrees of health, but become increasingly common with age. As our population ages and therefore becomes generally more unwell, the risks of surgery increase. Recent evidence suggests that emergency hernia repair is associated with worse outcomes than planned procedures. At present there are limited guidelines for the management of acutely symptomatic hernias and therefore practice varies between hospitals. This cohort study will capture information on patients treated in the UK for acutely symptomatic hernia, and will provide information on variation in assessment, and technical aspects of repair. It will also capture health utility data out to 90 days post discharge from hospital.

Official Title
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Management of Acutely Symptomatic Hernia: An Observational Study

Conditions
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Hernia, Emergencies, Surgery--Complications

Intervention / Treatment
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* Procedure: Emergency Hernia Repair
* Other: Conservative management


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged 18 years and over Patients admitted directly to the emergency surgery service (via A+E or GP) Patients referred to the emergency surgical team by another inpatient specialty Patients with a diagnosis of an acutely symptomatic hernia made by a specialist surgical trainee (ST3+) or Consultant Surgeon Willing to take part in the study Exclusion Criteria: Patients under 18 years of age Pregnant women Patients with a symptomatic parastomal, hiatal or diaphragmatic hernia Patients with a traumatic hernia Unable to consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients with acutely symptomatic abdominal wall hernia<br>Patients presenting to emergency surgical services with acutely symptomatic abdominal wall hernia (excluding parastomal). | Procedure: Emergency Hernia Repair<br>* Emergency repair of hernia using method selected by treating surgeon.<br>Other: Conservative management<br>* Treatment of hernia without resort to surgery<br>* Other names: Non-operative management;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| In hospital morbidity | As defined using the comprehensive complication index | up to 28 days after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality | Death occuring (binary) | Measured at baseline, 30 days post discharge, and 90 days post recruitment | 
| Hospital length of stay | Time from admission to discharge measured in days | Within 30 days of recruitment to study | 
| Unplanned readmission within 30 days | Unplanned readmission to hospital for any reason following treatment of hernia | Up to 30 days of recruitment | 
| Change in health utility | Measured using EQ-5D-5L questionnaire | Measured at baseline, 30 days post discharge and 90-days post recruitment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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outcome, hernia, emergency