Regional Variation in Hernia Repairs: 2017 Updated Report Findings

Number of Inguinal Hernia Procedures

There is clearly a lack of a concerted national strategy for ensuring inguinal hernia procedures are handled primarily by dedicated inguinal hernia specialists. As a result, there is huge regional variation in outcomes. 

The average inguinal hernia surgeon performed 24 inguinal hernia procedures in the North East in 2012/13 - a figure 26% higher than the London figure of 19. The median figure varied even more dramatically - with the median in the North West (14) more than double that in London. 

As the tables below show, 97% of surgeons perform fewer than 100 procedures. The number and percentage of surgeons performing 100 or more was very low in all regions. On this measure, London performed best with 3.5% performing 100 or more - compared to 1.5% in the Eastern region. 

87% of surgeons performed fewer than 50 procedures in 2012/13 - ranging from 91% in the East Midlands to 85% in the North West. 

More than two-thirds of surgeons perform two inguinal hernia procedures a month - or fewer. The South West performs worst on this measure, with 76% performing fewer than 25 compared to 66% in the North East. 

More than a third of surgeons performed between 1 and 4 procedures a year. In London, almost half of consultant surgeons fall into this category, compared to one in five in the North East. 

Over half (54%) of CCGs with published guidance are reducing access to inguinal hernia surgery, and 65 out of the 120 CCGs recommend a ‘‘watchful waiting’’ approach for asymptomatic or minimally symptomatic hernia repair, and therefore apply a restricted policy.