Analysis of the causes of bleeding and safety evaluation in day surgery for inguinal hernia patients

doi:10.3877/cma.j.issn.1674-392X.2025.02.010

Abstract

Abstract:

Objective

To analyze the factors associated with surgery-related bleeding in day surgery for inguinal hernia patients and evaluate the impact of bleeding on the safety of day surgery.

Methods

A retrospective analysis was conducted on clinical data of 1,328 patients who underwent day surgery for inguinal hernia in The First Affiliated Hospital of Chongqing Medical University between January 2023 and January 2025.The correlations between surgery-related bleeding and factors such as baseline characteristics, surgical approach, chronic medical history, presence of scrotal hernia, history of preperitoneal surgery, recurrent hernia, surgical site, and preoperative use of anticoagulants or antiplatelet medications were analyzed.Chi-square tests were used to screen for bleeding-related risk factors, followed by logistic regression analysis to identify independent risk factors.

Results

Among the 1,328 patients undergoing inguinal hernia day surgery, postoperative bleeding occurred in 40 cases (3.012%).Three patients required conversion from laparoscopy to open surgery to achieve hemostasis, with intraoperative findings revealing bleeding from the distal spermatic artery in scrotal hernia cases.The remaining patients were successfully managed conservatively without blood transfusions or reoperation.Both Chi-square tests and logistic regression analyses indicated that scrotal hernia, history of preperitoneal surgery, recurrent hernia, and preoperative use of antiplatelet medications were significantly associated with surgery-related bleeding(P<0.001).The OR values (95% CI) were 6.20 (2.73-14.08), 19.77 (6.81-57.42), 10.35 (4.13-25.97), and 8.56 (3.63-20.20), respectively.

Conclusion

Scrotal hernia, history of preperitoneal surgery, recurrent hernia, and preoperative use of antiplatelet medications are independent risk factors for bleeding in day surgery for inguinal hernia.These factors may delay patient discharge but rarely lead to severe complications when strict clinical protocols are followed.Preoperative reasonable adjustment of antiplatelet regimens, and selection of appropriate, individualized surgical approaches are critical to ensuring the safety of day surgery for inguinal hernia patients.

Key words: Day surgery, Hernia, inguinal, Surgical bleeding

Linxiang He, Yuehui Chen, Wei Zhang, Hong Liu, Xuehu Wang, Yu Zhao. Analysis of the causes of bleeding and safety evaluation in day surgery for inguinal hernia patients[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(02): 172-177.

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URL: https://zhshfbwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-392X.2025.02.010

https://zhshfbwkzz.cma-cmc.com.cn/EN/Y2025/V19/I02/172

Figures/Tables 3

年龄(岁, $\overset{ˉ}{x}$ ± s )	体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	性别[例(%)]		手术方式[例(%)]		患有慢性疾病[例(%)]
年龄(岁, $\overset{ˉ}{x}$ ± s )	体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	男性	女性	开放	腹腔镜	患有慢性疾病[例(%)]
65.79±14.87	23.16±2.42	1229(92.55)	99(7.45)	207(15.59)	1121(84.41)	432(32.53)
阴囊疝[例(%)]	有腹膜前手术史[例(%)]	复发疝[例(%)]	手术部位[例(%)]		用抗凝药物[例(%)]	用抗血小板药物[例(%)]
阴囊疝[例(%)]	有腹膜前手术史[例(%)]	复发疝[例(%)]	单侧	双侧	用抗凝药物[例(%)]	用抗血小板药物[例(%)]
20(1.51)	48(3.61)	80(6.02)	848(63.86)	480(36.14)	27(2.03)	160(12.05)

年龄(岁, $\overset{ˉ}{x}$ ± s )	体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	性别[例(%)]		手术方式[例(%)]		患有慢性疾病[例(%)]
年龄(岁, $\overset{ˉ}{x}$ ± s )	体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	男性	女性	开放	腹腔镜	患有慢性疾病[例(%)]
65.79±14.87	23.16±2.42	1229(92.55)	99(7.45)	207(15.59)	1121(84.41)	432(32.53)
阴囊疝[例(%)]	有腹膜前手术史[例(%)]	复发疝[例(%)]	手术部位[例(%)]		用抗凝药物[例(%)]	用抗血小板药物[例(%)]
阴囊疝[例(%)]	有腹膜前手术史[例(%)]	复发疝[例(%)]	单侧	双侧	用抗凝药物[例(%)]	用抗血小板药物[例(%)]
20(1.51)	48(3.61)	80(6.02)	848(63.86)	480(36.14)	27(2.03)	160(12.05)

影响因素	分类	无术后出血(n=1288)	术后出血(n=40)	χ ² 值	P值
性别	女性	95(7.38)	4(10.00)	0.387	0.534
	男性	1193(92.62)	36(90.00)
年龄	＜65 岁	511(39.67)	14(35.00)	0.355	0.552
	≥65 岁	777(60.33)	26(65.00)
体重指数	非超重	837(64.98)	22(55.00)	1.693	0.193
	超重(≥24 kg/m²)	451(35.02)	18(45.00)
手术方式	开放	195(15.14)	12(30.00)	6.511	0.111
	腹腔镜	1093(84.86)	28(70.00)
慢性疾病	否	873(67.78)	23(57.50)	1.868	0.172
	是	415(32.22)	17(42.50)
阴囊疝	否	1278(99.22)	30(75.00)	153.467	＜0.001
	是	10(0.78)	10(25.00)
腹膜前手术史	否	1249(96.97)	31(77.50)	42.223	＜0.001
	是	39(3.03)	9(22.50)
复发疝	否	1217(94.49)	31(77.50)	19.776	＜0.001
	是	71(5.51)	9(22.50)
手术部位	单侧	826(64.13)	22(55.00)	1.401	0.237
	双侧	462(35.87)	18(45.00)
抗凝药物	否	1265(98.21)	36(90.00)	0.727	0.394
	是	23(1.79)	4(10.00)
抗血小板药物	否	1141(88.59)	27(67.50)	16.279	＜0.001
	是	147(11.41)	13(32.50)

危险因素	β	S.E	Z 值	P 值	OR (95% CI)
阴囊疝	1.83	0.42	4.36	＜0.001	6.20(2.73~14.08)
腹膜前手术史	2.98	0.54	5.49	＜0.001	19.77(6.81~57.42)
复发疝	2.34	0.47	4.98	＜0.001	10.35(4.13~25.97)
抗血小板药物	2.15	0.44	4.90	＜0.001	8.56(3.63~20.20)

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