COMMUNITY SURVEILLANCE OF COMPLICATIONS AFTER HERNIA SURGERY

Objective - To assess the effect of a programme of postoperative community surveillance on the rate of detection of wound complications after operation for inguinal hernia. Design - Prospective audit of wound complications including complications recorded in case notes and those discovered by community surveillance. Setting - Academic surgical unit of three consultant surgeons. Patients - 510 patients undergoing elective inguinal hernia repair between June 1985 and August 1989. Results - The wound infection rate recorded in the hospital notes was 3% compared with 9% when additional information was obtained from community surveillance. Wound complications were detected in 143 (28%) patients by community surveillance compared with a complication rate of 7% in the case records for the same patients. Conclusions - Wound complications are common after clean surgery in patients discharged home early. Complication rates are a reflection not only of the standards of surgical practice but also the rigour with which they are sought. Before national comparative audit data are published the method of collection must be standardised. For short stay surgery this should include meaningful community surveillance.