Investigation of the complication, morbidity and mortality factors affecting the clinical hospitalization process after femoral hernioraphy

Aim: The study aims to investigate the risk factors of patients with femoral hernia as well as factors that affect the hospitalisation process, morbidity and mortality, particularly in terms of gender. Material and Methods: A total of 65 femoral hernia surgeries were performed in 29 Mayıs Public Hospitals between January 1, 2015 and June 30, 2019. Six patients with incomplete or unclear data were excluded, and the data of 59 patients were analysed. Percentage and frequency were used for discrete variables, whereas mean and standard deviation for continuous variables. Student’s t-test was used for independent variables according to the distribution status, whereas chi-square test was used for dichotomous variables, and the results for binary logistic regression were obtained. Results: Males were significantly more likely to have femoral hernia risk during old age [66.11years vs. 52.68 years (p=0.004), adjusted odds ratio (AOR): [0.87 (0.784, 0.969)(p= 0.011)]. In student’s t-test, male patients had shorter length of hospital stay (LOS). Hovewer the p value was found 0.79. In the binary multiple logistic regression for LOS value; In terms of gender, body mass index (BMI, kg/m2), age and complications; P value was found as 0.07 and ; AOR was found 2.2. With this result; The females have got the more LOS value than men as statistichally, for p=0.1 value. Conclusion: Femoral hernia frequently occurs in women; however, we found that its higher incidence is also can be found in men during old age, and after surgery, men are generally discharged earlier than women.


Introduction
Nowadays, any mention of femoral hernia tends to first bring to mind a clinical condition that is observed in women.
However, it is actually a type of hernia that is also observed in men. In addition, it should always be treated early in terms of strangulation and incarceration, which is an important consideration from a surgical standpoint. A total of 46% patients may develop this undesirable medical condition [1]. Therefore, we examined 59 patients with femoral hernia with high rates of complications, such as strangulation and incarceration, and compared our findings with those  Six patients with missing or unclear data were excluded.

Material and Methods
All subjects provided written informed consent before participation in the study.

Statistical Analysis
Percentage and frequency were used for discrete variables, whereas mean and standard deviation were used for continuous variables. Normality was tested using the Kolmogorov-Smirnov test. Student's t-test was used for independent variables, whereas chi-square test was used for discrete variables. The final results were obtained using binary logistic regression test. No difference was observed in BMI between men and women in terms of femoral hernia in both univariate and binary multiple regression analyses (Table 2). Moreover, no mortality was observed in the study. Cushieri A. reported that femoral hernia is a type of hernia most prone to strangulation, and its female-to-male ratio is 4 to 1 [6]. In our study, incarceration was detected in 5 of 11 cases with strangulation.

Eleven
Femoral hernias are more common in women than in men because of the weaker transversal fascia, which leads to the protrusion of the preperitoneal fat or viscus to the femoral ring and femoral canal [7]. In addition, the larger size of the pelvis in women compared to that in men is an important factor [8]. The presence of femoral hernia in children is typically due to a prominent connective tissue disease [9,10] ALBUZ ve ark. The factors that extend the clinical hospitalization process in femoral hernias a risk evaluation for thromboembolic cases in hernia surgery, and emphasised an age limit of 60 years and BMI of 30 kg/m2 [16]. Furthermore, we think that the operation of this case under emergency conditions may have contributed to the risk of venous thrombosis.
In the present study, considering the patients who experienced difficulties due to constipation, the common feature of all these patients was that they were operated for the resection and anastomosis of incarcerated small bowel loops after strangulation. Akrami et al. also reported this in a case presentation and described the same condition [17]. A predisposing factor for pain could not be identified in a patient with severe pain in the femoral herniorrhaphy site during hospitalisation, as Fränneby et al. [18] had emphasised. We believe that a rigorous technique in dissection will probably reduce the risk of pain and recurrence.

Limitations of the Study
The retrospective nature of this study may have not allowed adequate postoperative surveillance, and the study was therefore conducted within the limits of the data available in the documented case records. A multicenter prospective study is planned as the next step.

Conclusion
The risk of emergency surgery should always be considered in women and particularly older men with femoral hernia.
The risk of femoral hernia may be higher in elderly men than that in the young population. This diagnosis should not be overlooked by clinicians in cases presenting with chronic pelvic pain, and patients should be promptly directed to an evaluation for general surgery.