Clinical outcomes and risk prediction in inguinal and femoral hernia repair: a 12-year retrospective cohort study from a Colombian tertiary center.

purposeHernia repair is among the most common surgeries worldwide, but outcome data from Latin America remain scarce. This study evaluated the outcomes of inguinal and femoral hernia repair and internally validated a risk prediction score for postoperative complications.

methodsThis 12-year retrospective study included 628 adults undergoing hernia repair at a high-complexity hospital in Colombia (2013–2024). Data on demographics, procedures, and outcomes were collected. Multivariable logistic regression identified predictors of complications, and a 4-variable risk score was validated internally.

resultsMost patients were male (80.4%), with a mean age of 61.4 ± 16.7 years; 17.4% of the cohort underwent urgent surgery. The overall 30-day complication rate was 7.0% (95% CI, 5.1–9.3). One-year recurrence occurred in 10.9% of patients with available follow-up (n = 211, 33.6%). However, interpretation of recurrence rates was limited by substantial attrition and selection bias. Femoral hernias accounted for 8.9% of cases, predominantly affecting older women (mean age 75 years, 85.7% of cases female), with 67.9% of cases requiring urgent presentation and 26.8% resulting in postoperative complications. Laparoscopic repair was used in 20.1% of cases and showed increasing adoption over the study period, rising from 9.9% in the early years to 29% in later years. This increase reflects institutional improvement and proficiency. Laparoscopic repair was associated with lower unadjusted complication rates (2.4% vs. 8.2% for open repair; P = 0.019). However, this difference was confounded by selection bias, as laparoscopic patients tended to be younger, had lower ASA classifications, and underwent elective surgery more frequently. Independent predictors of postoperative complications included non-clean wound classification, urgent admission, hemodynamic instability, and age. The 4-variable clinical risk prediction model demonstrated good discrimination and calibration, with an optimism-corrected C-statistic of 0.754 (95% CI, 0.668–0.812) and a Hosmer–Lemeshow P-value of 0.243.

conclusionsInguinal and femoral hernia repair in a Latin American tertiary center produced outcomes comparable to those reported in European registry-based studies. The internally validated 4-variable risk score proved to be a practical and reliable tool for individualized complication risk stratification, preoperative counseling, resource allocation, and institutional benchmarking. Femoral hernias remain a high-risk presentation, particularly in older women, with high urgency rates and a 26.8% postoperative complication rate. These findings highlight the need for early identification and elective repair in this patient population to improve outcomes. Furthermore, the gradual institutional adoption of laparoscopic techniques indicates an improvement in surgical capacity, although outcome differences must be interpreted with caution, given potential confounding by patient selection. Efforts to enhance longitudinal follow-up infrastructure are essential for more accurate monitoring of recurrence and for quality-of-care evaluations.