Postoperative hematoma following inguinal herniorrhaphy: Patient characteristics leading to increased risk

Background: Although relatively infrequent, groin hematoma following inguinal herniorrhaphy is a morbid complication with major ramifications of mesh infection and hernia recurrence. We have sensed an increasing frequency of this complication in our tertiary referral practice and sought to determine whether or not significant risk factors could be identified. Methods: In this matched case - control study (1995-2003), we identified 53 patients with groin hematomas and paired them with 106 age- and gender-matched controls. Patient and procedure characteristics were analyzed using chi-square and both univariate and multivariable, conditional logistic regression analysis. Results: The 53 patients developing groin hematoma following inguinal hernia repair (mean age = 65, range 22-87, 90% male) were well matched with 106 controls (mean age = 65, range 22-87, 90% male). 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, endoscopic, or McVay) between groups. While univariate analysis identified Coumadin usage (P < 0.001, hazard ratio 19.1), valvular disease (P < 0.001, hazard ratio 10.9), atrial fibrillation (P = 0.02, hazard ratio 4.2), vascular disease (P =0.04, hazard ratio 2.2), blood abnormalities (P = 0.02, hazard ratio 3.2), and previous bleeding episodes (P = 0.02, hazard ratio 4.9) as significant factors, only preoperative Coumadin usage was important in multivariate analysis. Conclusion: The crucial risk factor for groin hematoma developing in patients undergoing inguinal hernia repair is preoperative need for Coumadin therapy. Although the perioperative management of anticoagulation in patients undergoing inguinal herniorrhaphy is not clearly defined, meticulous management of patients requiring Coumadin therapy seems prudent.