Barriers to inguinal hernia repair in Ghana: prospective, multi-centre cohort study

Abstract

Inguinal hernia (IH) is the most common general surgical pathology in Ghana with hernia repair rate very
low. The objective was to assess patient-perceived barriers to IH repair in Ghana and identify predictors of
experiencing delays until surgery. A multicenter prospective study was conducted during the Ghana Hernia
Society outreach. Data regarding diagnosis using Kingsnorth’s classification of IH, age of patients, duration
of hernia, reason for delay in repair, insurance status, American Society of Anesthesiologists (ASA) class,
travel distance, region, hospital, and waiting times were obtained from patients and folders. Multivariable
linear regression models were constructed to analyze delay until surgery and Kingsnorth’s classification
while controlling for the covariates of age, insurance status, ASA class among others. The most common
reasons were queues for surgery (23%), poverty (10%), and seeking traditional medicine (9%). On
multivariate linear regression, increasing age and ASA class III were predictors of longer delays. Patients
experienced significant increase of 1.1 years delay to surgery for every 10 year increase in of age. ASA Class
III patients were significantly more likely to be delayed by 11.5 years compared to ASA Class I patients.
Efforts should be made to address and overcome the barriers to IH repair identified.