Mesh-based inguinal hernia repairs in an integrated healthcare system and surgeon and hospital volume: a cohort study of 110,808 patients from over a decade.
Hernia repair
Hospital volume
Inguinal
Reoperation
Surgeon volume
Surgical approach
Journal
Hernia : the journal of hernias and abdominal wall surgery
ISSN: 1248-9204
Titre abrégé: Hernia
Pays: France
ID NLM: 9715168
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
received:
09
12
2022
accepted:
19
04
2023
medline:
5
10
2023
pubmed:
6
5
2023
entrez:
6
5
2023
Statut:
ppublish
Résumé
The aim of this study was to describe a cohort of patients who underwent inguinal hernia repair within a United States-based integrated healthcare system (IHS) and evaluate the risk for postoperative events by surgeon and hospital volume within each surgical approach, open, laparoscopic, and robotic. Patients aged ≥ 18 years who underwent their first inguinal hernia repair were identified for a cohort study (2010-2020). Average annual surgeon and hospital volume were broken into quartiles with the lowest volume quartile as the reference group. Multiple Cox regression evaluated risk for ipsilateral reoperation following repair by volume. All analyses were stratified by surgical approach (open, laparoscopic, and robotic). 110,808 patients underwent 131,629 inguinal hernia repairs during the study years; procedures were performed by 897 surgeons at 36 hospitals. Most repairs were open (65.4%), followed by laparoscopic (33.5%) and robotic (1.1%). Reoperation rates at 5 and 10 years of follow-up were 2.4% and 3.4%, respectively; rates were similar across surgical groups. In adjusted analysis, surgeons with higher laparoscopic volumes had a lower reoperation risk (27-46 average annual repairs: hazard ratio [HR] = 0.63, 95% confidence interval [CI] 0.53-0.74; ≥ 47 repairs: HR 0.53, 95% CI 0.44-0.64) compared to those in the lowest volume quartile (< 14 average annual repairs). No differences in reoperation rates were observed in reference to surgeon or hospital volume following open or robotic inguinal hernia repair. High-volume surgeons may reduce reoperation risk following laparoscopic inguinal hernia repair. We hope to better identify additional risk factors for inguinal hernia repair complications and improve patient outcomes with future studies.
Identifiants
pubmed: 37148362
doi: 10.1007/s10029-023-02796-x
pii: 10.1007/s10029-023-02796-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1209-1223Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.
Références
Ruhl CE, Everhart JE (2007) Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol 165(10):1154–1161. https://doi.org/10.1093/aje/kwm011
doi: 10.1093/aje/kwm011
pubmed: 17374852
Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362(9395):1561–1571. https://doi.org/10.1016/S0140-6736(03)14746-0
doi: 10.1016/S0140-6736(03)14746-0
pubmed: 14615114
HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1–165. https://doi.org/10.1007/s10029-017-1668-x
doi: 10.1007/s10029-017-1668-x
Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 83(5):1045–51, v-vi. https://doi.org/10.1016/S0039-6109(03)00132-4 .
Howard R, Gunaseelan V, Brummett C, Waljee J, Englesbe M, Telem D (2020) New Persistent Opioid Use After Inguinal Hernia Repair. Ann Surg. https://doi.org/10.1097/sla.0000000000004560
doi: 10.1097/sla.0000000000004560
pubmed: 33177414
Fitzgibbons RJ, Jr., Forse RA (2015) Clinical practice. Groin hernias in adults. N Engl J Med 372(8):756–63. https://doi.org/10.1056/NEJMcp1404068 .
Nguyen DK, Amid PK, Chen DC (2016) Groin Pain After Inguinal Hernia Repair. Adv Surg 50(1):203–220. https://doi.org/10.1016/j.yasu.2016.04.003
doi: 10.1016/j.yasu.2016.04.003
pubmed: 27520873
Kehlet H, Bay-Nielsen M (2008) Nationwide quality improvement of groin hernia repair from the Danish Hernia Database of 87,840 patients from 1998 to 2005. Hernia 12(1):1–7. https://doi.org/10.1007/s10029-007-0285-5
doi: 10.1007/s10029-007-0285-5
pubmed: 17939015
Aquina CT, Probst CP, Kelly KN, Iannuzzi JC, Noyes K, Fleming FJ, Monson JR (2015) The pitfalls of inguinal herniorrhaphy: Surgeon volume matters. Surgery 158(3):736–746. https://doi.org/10.1016/j.surg.2015.03.058
doi: 10.1016/j.surg.2015.03.058
pubmed: 26036880
Köckerling F, Bittner R, Kraft B, Hukauf M, Kuthe A, Schug-Pass C (2017) Does surgeon volume matter in the outcome of endoscopic inguinal hernia repair? Surg Endosc 31(2):573–585. https://doi.org/10.1007/s00464-016-5001-z
doi: 10.1007/s00464-016-5001-z
pubmed: 27334968
Maneck M, Köckerling F, Fahlenbrach C, Heidecke CD, Heller G, Meyer HJ, Rolle U, Schuler E, Waibel B, Jeschke E, Günster C (2020) Hospital volume and outcome in inguinal hernia repair: analysis of routine data of 133,449 patients. Hernia 24(4):747–757. https://doi.org/10.1007/s10029-019-02091-8
doi: 10.1007/s10029-019-02091-8
pubmed: 31786700
Köckerling F, Sheen AJ, Berrevoet F, Campanelli G, Cuccurullo D, Fortelny R, Friis-Andersen H, Gillion JF, Gorjanc J, Kopelman D, Lopez-Cano M, Morales-Conde S, Österberg J, Reinpold W, Simmermacher RKJ, Smietanski M, Weyhe D, Simons MP (2019) Accreditation and certification requirements for hernia centers and surgeons: the ACCESS project. Hernia 23(2):185–203. https://doi.org/10.1007/s10029-018-1873-2
doi: 10.1007/s10029-018-1873-2
pubmed: 30671899
pmcid: 6456484
Paxton EW, Prentice HA, Inacio MC, Dillon MT, Page RS, Rasmussen JV, Salomonsson B, de Steiger R, Navarro RA (2017) Are we throwing the baby out with the bath water? J Shoulder Elbow Surg 26(5):e137–e139. https://doi.org/10.1016/j.jse.2017.02.003
doi: 10.1016/j.jse.2017.02.003
pubmed: 28318849
Köckerling F, Simon T, Hukauf M, Hellinger A, Fortelny R, Reinpold W, Bittner R (2018) The Importance of Registries in the Postmarketing Surveillance of Surgical Meshes. Ann Surg 268(6):1097–1104. https://doi.org/10.1097/sla.0000000000002326
doi: 10.1097/sla.0000000000002326
pubmed: 28594740
Lee TH, Choudhuri A, Ulisney K, Swiger J, Poulose B, Rosen M, Gibeily G (2020) Use of real-world registry data: a hernia mesh example. Hernia 24(3):587–590. https://doi.org/10.1007/s10029-019-02085-6
doi: 10.1007/s10029-019-02085-6
pubmed: 31776875
Kyle-Leinhase I, Köckerling F, Jørgensen LN, Montgomery A, Gillion JF, Rodriguez JAP, Hope W, Muysoms F (2018) Comparison of hernia registries: the CORE project. Hernia 22(4):561–575. https://doi.org/10.1007/s10029-017-1724-6
doi: 10.1007/s10029-017-1724-6
pubmed: 29307057
pmcid: 6061062
Kaiser Permanente (2022) Fast facts. https://about.kaiserpermanente.org/who-we-are/fast-facts . Accessed 12 April 2022
Society for Surgery of the Alimentary Tract (2007) SSAT patient care guidelines. Surgical repair of groin hernias. J Gastrointest Surg 11(9):1228–30. https://doi.org/10.1007/s11605-007-0199-7 .
Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13(4):343–403. https://doi.org/10.1007/s10029-009-0529-7
doi: 10.1007/s10029-009-0529-7
pubmed: 19636493
pmcid: 2719730
Rosenberg J, Bisgaard T, Kehlet H, Wara P, Asmussen T, Juul P, Strand L, Andersen FH, Bay-Nielsen M (2011) Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull 58(2):C4243
pubmed: 21299930
Aquina CT, Fleming FJ, Becerra AZ, Xu Z, Hensley BJ, Noyes K, Monson JRT, Jusko TA (2017) Explaining variation in ventral and inguinal hernia repair outcomes: A population-based analysis. Surgery 162(3):628–639. https://doi.org/10.1016/j.surg.2017.03.013
doi: 10.1016/j.surg.2017.03.013
pubmed: 28528663
Christophersen C, Baker JJ, Fonnes S, Andresen K, Rosenberg J (2021) Lower reoperation rates after open and laparoscopic groin hernia repair when performed by high-volume surgeons: a nationwide register-based study. Hernia 25(5):1189–1197. https://doi.org/10.1007/s10029-021-02400-0
doi: 10.1007/s10029-021-02400-0
pubmed: 33835325
Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36(1):8–27. https://doi.org/10.1097/00005650-199801000-00004
doi: 10.1097/00005650-199801000-00004
pubmed: 9431328
Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43(11):1130–1139. https://doi.org/10.1097/01.mlr.0000182534.19832.83
doi: 10.1097/01.mlr.0000182534.19832.83
pubmed: 16224307
Clark TG, Altman DG, De Stavola BL (2002) Quantification of the completeness of follow-up. Lancet 359(9314):1309–1310. https://doi.org/10.1016/s0140-6736(02)08272-7
doi: 10.1016/s0140-6736(02)08272-7
pubmed: 11965278
Madion M, Goldblatt MI, Gould JC, Higgins RM (2021) Ten-year trends in minimally invasive hernia repair: a NSQIP database review. Surg Endosc 35(12):7200–7208. https://doi.org/10.1007/s00464-020-08217-9
doi: 10.1007/s00464-020-08217-9
pubmed: 33398576
Burcharth J, Pedersen M, Bisgaard T, Pedersen C, Rosenberg J (2013) Nationwide prevalence of groin hernia repair. PLoS ONE 8(1):54367. https://doi.org/10.1371/journal.pone.0054367
doi: 10.1371/journal.pone.0054367
Ellison-Barnes A, Johnson S, Gudzune K (2021) Trends in obesity prevalence among adults aged 18 through 25 years, 1976–2018. JAMA 326(20):2073–2074. https://doi.org/10.1001/jama.2021.16685
doi: 10.1001/jama.2021.16685
pubmed: 34812876
pmcid: 8611474
Smink DS, Paquette IM, Finlayson SR (2009) Utilization of laparoscopic and open inguinal hernia repair: a population-based analysis. J Laparoendosc Adv Surg Tech A 19(6):745–748. https://doi.org/10.1089/lap.2009.0183
doi: 10.1089/lap.2009.0183
pubmed: 19916771
Trevisonno M, Kaneva P, Watanabe Y, Fried GM, Feldman LS, Andalib A, Vassiliou MC (2015) Current practices of laparoscopic inguinal hernia repair: a population-based analysis. Hernia 19(5):725–733. https://doi.org/10.1007/s10029-015-1358-5
doi: 10.1007/s10029-015-1358-5
pubmed: 25754219
Burcharth J (2014) The epidemiology and risk factors for recurrence after inguinal hernia surgery. Dan Med J 61(5):B4846
pubmed: 24814748
Tonelli CM, Lorenzo I, Bunn C, Kulshrestha S, Abdelsattar ZM, Cohn T, Luchette FA, Baker MS (2022) Contemporary matched-cohort comparison of surgical approach to inguinal hernia repair: are minimally invasive approaches associated with higher rates of recurrence? J Am Coll Surg 235(1):119–127. https://doi.org/10.1097/xcs.0000000000000235
doi: 10.1097/xcs.0000000000000235
pubmed: 35703969
Mercier G, Spence J, Ferreira C, Delay JM, Meunier C, Millat B, Nguyen TL, Seguret F (2018) Postoperative rehabilitation may reduce the risk of readmission after groin hernia repair. Sci Rep 8(1):6759. https://doi.org/10.1038/s41598-018-25276-0
doi: 10.1038/s41598-018-25276-0
pubmed: 29712995
pmcid: 5928219
Bourgon AL, Fox JP, Saxe JM, Woods RJ (2015) Outcomes and charges associated with outpatient inguinal hernia repair according to method of anesthesia and surgical approach. Am J Surg 209(3):468–472. https://doi.org/10.1016/j.amjsurg.2014.09.021
doi: 10.1016/j.amjsurg.2014.09.021
pubmed: 25547092
Fernandez-Alberti J, Mata L, Orrego F, Medina P, Bogetti D, Porto EA, Pirchi DE (2022) Laparoscopic inguinal hernia repair: impact of surgical time in the learning curve. Surg Endosc. https://doi.org/10.1007/s00464-022-09807-5
doi: 10.1007/s00464-022-09807-5
pubmed: 36477644
Andresen K, Friis-Andersen H, Rosenberg J (2016) Laparoscopic repair of primary inguinal hernia performed in public hospitals or low-volume centers have increased risk of reoperation for recurrence. Surg Innov 23(2):142–147. https://doi.org/10.1177/1553350615596636
doi: 10.1177/1553350615596636
pubmed: 26209630
Karter AJ, Ferrara A, Liu JY, Moffet HH, Ackerson LM, Selby JV (2002) Ethnic disparities in diabetic complications in an insured population. JAMA 287(19):2519–2527. https://doi.org/10.1001/jama.287.19.2519
doi: 10.1001/jama.287.19.2519
pubmed: 12020332
Koebnick C, Langer-Gould AM, Gould MK, Chao CR, Iyer RL, Smith N, Chen W, Jacobsen SJ (2012) Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data. Perm J 16(3):37–41. https://doi.org/10.7812/TPP/12-031
doi: 10.7812/TPP/12-031
pubmed: 23012597
pmcid: 3442759
Köckerling F (2017) Data and outcome of inguinal hernia repair in hernia registers - a review of the literature. Innov Surg Sci 2(2):69–79. https://doi.org/10.1515/iss-2016-0206
doi: 10.1515/iss-2016-0206
pubmed: 31579739
pmcid: 6754003
Paxton EW, Inacio MC, Kiley ML (2012) The Kaiser Permanente implant registries: effect on patient safety, quality improvement, cost effectiveness, and research opportunities. Perm J 16(2):36–44. https://doi.org/10.7812/TPP/12-008
doi: 10.7812/TPP/12-008
pubmed: 22745614
pmcid: 3383159
Paxton EW, Kiley ML, Love R, Barber TC, Funahashi TT, Inacio MC (2013) Kaiser Permanente implant registries benefit patient safety, quality improvement, cost-effectiveness. Jt Comm J Qual Patient Saf 39(6):246–252. https://doi.org/10.1016/s1553-7250(13)39033-3
doi: 10.1016/s1553-7250(13)39033-3
pubmed: 23789161
Paxton EW, Inacio MC, Khatod M, Yue EJ, Namba RS (2010) Kaiser Permanente National Total Joint Replacement Registry: aligning operations with information technology. Clin Orthop Relat Res 468(10):2646–2663. https://doi.org/10.1007/s11999-010-1463-9
doi: 10.1007/s11999-010-1463-9
pubmed: 20652461
pmcid: 3049637