General Surgery ; education ; Internship and Residency ; methods ; organization & administration ; Organizational Culture ; United States

Delivery of Health Care ; economics ; organization & administration ; General Surgery ; Health Care Rationing ; Humans ; Quality of Life ; Singapore ; United Kingdom ; United States

Career Choice ; Female ; General Surgery ; manpower ; Humans ; Male ; Physicians, Women ; supply & distribution ; Prejudice ; Schools, Medical ; organization & administration

INTRODUCTIONWe aimed to report the outcomes of inguinal hernia repair performed at Tan Tock Seng Hospital and compare them with those performed at dedicated hernia centres.

METHODSWe retrospectively analysed the medical records and telephone interviews of 520 patients who underwent inguinal hernia repair in 2010.

RESULTSThe majority of the patients were male (498 [95.8%] men vs. 22 [4.2%] women). The mean age was 59.9 ± 15.7 years. Most patients (n = 445, 85.6%) had unilateral hernias (25.8% direct, 64.3% indirect, 9.9% pantaloon). The overall recurrence rate was 3.8%, with a mean time to recurrence of 12.0 ± 8.6 months. Risk factors for recurrence included contaminated wounds (odds ratio [OR] 50.325; p = 0.004), female gender (OR 8.757; p = 0.003) and pantaloon hernias (OR 5.059; p = 0.013). Complication rates were as follows: chronic pain syndrome (1.2%), hypoaesthesia (5.2%), wound dehiscence (0.4%), infection (0.6%), haematoma/seroma (4.8%), urinary retention (1.3%) and intraoperative visceral injury (0.6%). Most procedures were open repairs (67.7%), and laparoscopic repair constituted 32.3% of all the inguinal hernia repairs. Open repairs resulted in longer operating times than laparoscopic repairs (86.6 mins vs. 71.6 mins; p < 0.001), longer hospital stays (2.7 days vs. 0.7 days; p = 0.020) and a higher incidence of post-repair hypoaesthesia (6.8% vs. 1.8%; p = 0.018). However, there were no significant differences in recurrence or other complications between open and laparoscopic repair.

CONCLUSIONA general hospital with strict protocols and teaching methodologies can achieve inguinal hernia repair outcomes comparable to those of dedicated hernia centres.

Adult ; Aged ; Aged, 80 and over ; Female ; Hernia, Inguinal ; surgery ; Herniorrhaphy ; methods ; standards ; Hospitals, General ; organization & administration ; Hospitals, Special ; organization & administration ; Humans ; Male ; Medical Records ; Middle Aged ; Recurrence ; Retrospective Studies ; Singapore ; Treatment Outcome ; Young Adult

COVID-19/prevention & control* ; Communicable Disease Control ; General Surgery/organization & administration* ; Guidelines as Topic ; Health Care Rationing ; Health Services Needs and Demand ; Health Workforce ; Humans ; Practice Guidelines as Topic ; SARS-CoV-2 ; Singapore/epidemiology* ; Surgical Procedures, Operative ; Triage