Protocol for a global cohort study: HernIas, Pathway and Planetary Outcomes for Inguinal Hernia Surgery (HIPPO)

HIPPO Cohort Study Protocol

Abstract

Introduction: Inguinal hernia repair is one of the most common elective operations globally which was not prioritised during the pandemic. Data from the National Health Service in the United Kingdom suggests that 74,822 patients were awaiting inguinal hernia repair in June 2022. The primary aim of this study is to identify the variation in access and quality for inguinal hernia repair, using it as a tracer condition for elective healthcare.

Methods: This study will be a prospective global cohort study in which hospitals performing inguinal hernia repairs in any country are eligible to participate. Consecutive patients of all ages undergoing inguinal hernia repair will be included during 4-week periods. Both elective and emergency procedures will be included. The primary outcomes were defined as a measurement set mapped to the attributes of WHO Health System Building Blocks. Emergency rate, bowel resection rate and waiting times to elective repair will be used to evaluate access. Mesh use rate, day-case adoption rate and 30-day postoperative complications will be used to evaluate quality. These measures will be described across the four income groups as described by the World Bank classification system (high-, upper-middle, lower-middle and low-income groups). Association of postoperative complications and pre-specified variables will be tested using a multilevel logistic regression model.

Discussion: This study will provide granular data on assessment of elective healthcare. It will also identify how quality in inguinal hernia repair is varying across the world. This data will inform policymakers and governments of components in the pathway which need to be improved to reduce waiting times for inguinal hernia repair.