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Purpose: The mortality following emergency groin hernia repair in Denmark is more than twice as high (7%) as in comparable countries. This article describes in detail the population that died following emergency herniotomy in order to identify aspects of care that may improve outcome., Methods: Patients > or =18 years of age who died within 30 days following emergency hernia surgery from June 2003 through June 2008 were identified using the Danish Hernia Database (DHDB) and the Danish National Hospital Registry (n = 158). In total, 156 records were collected and reviewed., Results: The median age of the patients was 83 years (range 54-97) and 80% had co-morbidity. There was an almost equal distribution of men and women and inguinal and femoral hernias. More than 60% of the patients with a hernia upon admission had symptoms lasting > or =48 h prior to admission and 41% were not examined for hernia at admission and had delayed diagnosis. Only 23% underwent surgery within 8 h of admission and 35% of the patients were admitted to a medical or non-abdominal surgical ward. Laparotomy and bowel resections were frequent (53.1 and 49.2%, respectively)., Conclusion: Delay to admission, diagnosis and surgery are common in patients undergoing emergency groin hernia surgery in Denmark. Patients admitted with acute abdominal symptoms should be examined for a hernia and operated on soon after admission.