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Mao RMD, Williams TP, Klimberg VS, Radhakrishnan RS, DeAnda A, Perez A, Walker JP, Mileski WJ, Tyler DS. Quality of Surgical Care Within the Criminal Justice Health Care System. JAMA Surg 2024; 159:179-184. [PMID: 38055231 PMCID: PMC10701659 DOI: 10.1001/jamasurg.2023.6236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/03/2023] [Indexed: 12/07/2023]
Abstract
Importance Individuals who are incarcerated represent a vulnerable group due to concerns about their ability to provide voluntary and informed consent, and there are considerable legal protections regarding their participation in medical research. Little is known about the quality of surgical care received by this population. Objective To evaluate perioperative surgical care provided to patients who are incarcerated within the Texas Department of Criminal Justice (TDCJ) and compare their outcomes with that of the general nonincarcerated population. Design, Setting, and Participants This cohort study analyzed data from patients who were incarcerated within the TDCJ and underwent general or vascular surgery at the University of Texas Medical Branch (UTMB) from 2012 to 2021. Case-specific outcomes for a subset of these patients and for patients in the general academic medical center population were obtained from the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) and compared. Additional quality metrics (mortality index, length of stay index, and excess hospital days) from the Vizient Clinical Data Base were analyzed for patients in the incarcerated and nonincarcerated groups who underwent surgery at UTMB in 2020 and 2021 to provide additional recent data. Patient-specific demographics, including age, sex, and comorbidities were not available for analysis within this data set. Main Outcome and Measures Perioperative outcomes (30-day morbidity, mortality, and readmission rates) were compared between the incarcerated and nonincarcerated groups using the Fisher exact test. Results The sample included data from 6675 patients who were incarcerated and underwent general or vascular surgery at UTMB from 2012 to 2021. The ACS-NSQIP included data (2012-2021) for 2304 patients who were incarcerated and 602 patients who were not and showed that outcomes were comparable between the TDCJ population and that of the general population treated at the academic medical center with regard to 30-day readmission (6.60% vs 5.65%) and mortality (0.91% vs 1.16%). However, 30-day morbidity was significantly higher in the TDCJ population (8.25% vs 5.48%, P = .01). The 2020 and 2021 data from the Vizient Clinical Data Base included 629 patients who were incarcerated and 2614 who were not and showed that the incarcerated and nonincarcerated populations did not differ with regard to 30-day readmission (12.52% vs 11.30%) or morbidity (1.91% vs 2.60%). Although the unadjusted mortality rate was significantly lower in the TDCJ population (1.27% vs 2.68%, P = .04), mortality indexes, which account for case mix index, were similar between the 2 populations (1.17 vs 1.12). Conclusions and Relevance Findings of this cohort study suggest that patients who are incarcerated have equivalent rates of mortality and readmission compared with a general academic medical center population. Future studies that focus on elucidating the potential factors associated with perioperative morbidity and exploring long-term surgical outcomes in the incarcerated population are warranted.
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Affiliation(s)
- Rui-Min D. Mao
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | - Taylor P. Williams
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | | | | | - Abe DeAnda
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | - Alexander Perez
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | - John P. Walker
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | - William J. Mileski
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | - Douglas S. Tyler
- Department of Surgery, The University of Texas Medical Branch, Galveston
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Kong L, Wang J, Guo K. Effect of general and spinal anaesthesia on post-operative wound healing during laparoscopic totally extraperitoneal inguinal hernia repair: A meta-analysis. Int Wound J 2024; 21:e14670. [PMID: 38361225 PMCID: PMC10869659 DOI: 10.1111/iwj.14670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 02/17/2024] Open
Abstract
Totally extraperitoneal prosthetic (TEP) is a surgical technique for the treatment of hernia. The purpose of this research is to compare the efficacy of both general anaesthesia and spine anaesthesia for TEP herniorrhaphy. The number of patients who received TEP operations related to the injury from 2008 to 2022 was counted in this study. Patients with TEP operation were classified into general anaesthesia and spine anaesthesia. In this research, 186 related articles were found in the data base, and in the end, 8 were analysed. This study involved 2452 cases of hernia. The data of the operation time, the infection of the wound and the bleeding of the wound were analysed. The analysis of the data was done with RevMan 5.3. Results indicated that there was no significant difference between general anaesthesia and spinal anaesthesia in post-surgical rates for post-operative wound infection (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.49-1.83; p = 0.86); In general anaesthesia, there was no difference in the risk of post-operative wound haematoma when compared with those treated with spinal anaesthesia (OR, 2.96; 95% CI, 0.37-23.69; p = 0.31). In the seven trials, there was no difference in the duration of the surgery between the general anaesthetic and the spinal anaesthesia group (mean difference, -1.44; 95% CI, -4.11 to 1.22; p = 0.29). Data from the available meta-analysis indicate that there is no difference in the risk of post-operative wound infection or wound haematoma when treated with TEP.
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Affiliation(s)
- Liang Kong
- Department of AnaesthesiologyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Jiming Wang
- Department of AnaesthesiologyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Kai Guo
- Department of AnaesthesiologyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
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3
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Hakeem A, Saqib SU, Zafar H. Return to Work in Patients With Unilateral Inguinal Hernia Surgery: A Comparative Study Between Laparoscopic Transabdominal Preperitoneal Approach and Lichtenstein Tension-Free Mesh Repair. Cureus 2023; 15:e39202. [PMID: 37378228 PMCID: PMC10292120 DOI: 10.7759/cureus.39202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
Objective The objective of this prospective cohort study was to compare the time to return to work between patients who underwent laparoscopic transabdominal preperitoneal (TAPP) hernia repair and those who underwent Lichtenstein tension-free hernia repair with mesh for unilateral inguinal hernia. Methodology Patients were registered for unilateral inguinal hernia review at Aga Khan University Hospital, Karachi, Pakistan, from May 2016 to April 2017 and followed till April 2020. All patients aged 16-65 planned for unilateral transabdominal preperitoneal hernia repair or Lichtenstein tension-free hernia mesh repair were included. Patients with bilateral inguinal hernia repair, limited activity, or above retirement age were excluded. A non-probability consecutive sampling technique was implemented, and patients were divided into two cohort groups: Group A underwent laparoscopic transabdominal preperitoneal hernia repair, while Group B underwent Lichtenstein tension-free mesh repair. Patients were followed up at one week to inquire about the resumption of activities and then at one and three years for recurrence. Results Sixty-four patients met the inclusion criteria; three patients opted out of research, and 61 patients agreed to participate; one patient was excluded due to the conversion of the procedure. The remaining 30 in Group A and 30 in Group B were followed for the study period. The mean time to return to work in Group A was 5.33 ± 4.46 days; in Group B, it was 6.83 ± 4.58 days, with a p-value of 0.657. One recurrence was observed at three years in Group A. Conclusion Although the time to return to work at our hospital was slightly shorter in laparoscopic hernia repair than in the open technique, the results were not statistically significant. In addition, there was no significant difference in hernia recurrence at the one-year follow-up between laparoscopic transabdominal preperitoneal hernia repair and Lichtenstein tension-free hernia mesh repair for unilateral inguinal hernia.
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Affiliation(s)
- Abdul Hakeem
- Department of Surgery, Aga Khan University Hospital, Karachi, PAK
| | | | - Hasnain Zafar
- Department of Surgery, Aga Khan University Hospital, Karachi, PAK
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4
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Lee Y, Tessier L, Jong A, Zhao D, Samarasinghe Y, Doumouras A, Saleh F, Hong D. Differences in in-hospital outcomes and healthcare utilization for laparoscopic versus open approach for emergency inguinal hernia repair: a nationwide analysis. HERNIA : THE JOURNAL OF HERNIAS AND ABDOMINAL WALL SURGERY 2023; 27:601-608. [PMID: 36645563 DOI: 10.1007/s10029-023-02742-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE There has been a growing debate of whether laparoscopic or open surgical techniques are superior for inguinal hernia repair. For incarcerated and strangulated inguinal hernias, the laparoscopic approach remains controversial. This study aims to be the first nationwide analysis to compare clinical and healthcare utilization outcomes between laparoscopic and open inguinal hernia repair in an emergency setting. METHODS A retrospective analysis of the National Inpatient Sample was performed. All patients who underwent laparoscopic inguinal hernia repair (LIHR) and open inguinal hernia repair (OIHR) between October 2015 and December 2019 were included. The primary outcome was mortality, and secondary outcomes include post-operative complications, ICU admission, length of stay (LOS), and total admission cost. Two approaches were compared using univariate and multivariate logistic and linear regression. RESULTS Between the years 2015 and 2019, 17,205 patients were included. Among these, 213 patients underwent LIHR and 16,992 underwent OIHR. No difference was observed between laparoscopic and open repair for mortality (odds ratio [OR] 0.80, 95% CI [0.25, 2.61], p = 0.714). Additionally, there was no significant difference between groups for post-operative ICU admission (OR 1.11, 95% CI [0.74, 1.67], p = 0.614), post-operative complications (OR 1.09, 95% CI [0.76, 1.56], p = 0.647), LOS (mean difference [MD]: -0.02 days, 95% CI [- 0.56, 0.52], p = 0.934), or total admission cost (MD: $3,028.29, 95% CI [$- 110.94, $6167.53], p = 0.059). CONCLUSION Laparoscopic inguinal hernia repair is comparable to the open inguinal hernia repair with respect to low rates of morbidity, mortality as well as healthcare resource utilization.
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Affiliation(s)
- Y Lee
- Division of General Surgery, McMaster University, Hamilton, ON, Canada.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - L Tessier
- Division of General Surgery, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - A Jong
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - D Zhao
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Y Samarasinghe
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - A Doumouras
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - F Saleh
- Division of General Surgery, McMaster University, Hamilton, ON, Canada.,Division of General Surgery, Department of Surgery, William Osler Health System, Brampton, ON, Canada
| | - D Hong
- Division of General Surgery, McMaster University, Hamilton, ON, Canada.
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5
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Lam CS, Dhedli PK, Russell S, Stedman FE, Hall NJ. Cost-Effectiveness of Laparoscopic and Open Pediatric Inguinal Hernia Repair. J Laparoendosc Adv Surg Tech A 2022; 32:805-810. [PMID: 35483082 DOI: 10.1089/lap.2021.0800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: Laparoscopic inguinal hernia (IH) repair is an alternative to open surgery. A potential advantage of laparoscopic repair is prevention of contralateral metachronous hernia although some studies report higher recurrence rate. We aim to determine the cost-effectiveness of open versus laparoscopic IH repair taking into account metachronous and recurrence rates. Methods: Retrospective single-center study of children (<5 years) undergoing elective open or laparoscopic repair for a unilateral IH between February 2018 and October 2019. Ten cases in each of four groups were included (open day case, open overnight, laparoscopic day case, and laparoscopic overnight). Cases incurring a higher cost due to comorbidities or additional procedure were excluded. Patient-level information and costing system data were obtained from the hospital finance. Mean (standard deviation [SD]) procedural cost was compared for open and laparoscopic procedures. A financial model was created factoring metachronous and recurrent rates. Results: Cost of open day case repair was £1866.24 (SD: 311.15) compared with £2210.13 (SD: 391.36) for day case laparoscopic repair. For overnight repair, cost of open was £2442.82 (SD: 497.05) compared with £2585.35 (SD: 384.66) for laparoscopic. On calculating the cost-effectiveness point using the difference in metachronous and recurrence rate between the two procedures, laparoscopic is more cost-effective than open day case repair at 18.43%. For overnight repair, the difference rate is 5.84%. Conclusion: Our data suggest that based on metachronous and recurrence rates in the current literature, laparoscopic IH repair is more cost-effective than open repair for cases requiring overnight stay, whereas for day case procedures open IH repair is more cost-effective.
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Affiliation(s)
- Christine S Lam
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom
| | - Pavleen K Dhedli
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Samantha Russell
- Finance Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Francesca E Stedman
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom
| | - Nigel J Hall
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom.,University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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6
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Faessen J, Schoemakers B, VAN Veenendaal N, Visschers R, Hoofwijk A, Stoot J. Time-efficiency and hospital costs of open compared with laparoscopic groin hernia repair in a teaching hospital. Minerva Surg 2021; 76:271-280. [PMID: 34080822 DOI: 10.23736/s2724-5691.21.08589-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Time efficiency and hospital costs may influence the preferred method of groin hernia repair. Despite growing expertise in laparoscopic hernia repair, knowledge on the actual costs and the potential financial advantages over open hernia repair are limited. METHODS A single-center retrospective cohort study comparing hospital costs and time-efficiency of open-mesh (Lichtenstein) and laparoscopic groin hernia repair between 2010 and 2015, including a comparison of surgeons and residents, was conducted. Secondary outcomes were length of hospital stay, complication and recurrence rates. RESULTS Nine hundred forty-seven open and 449 laparoscopic groin hernia repairs were included. Unilateral open repair showed a shorter operation theatre occupancy (63.5 min±17.2 vs. 71.9 min±19.9, P<0.001) and lower total costs (€ 974.51±266.67 vs. € 1165.32±285.94, P<0.001) compared with laparoscopic repair. Residents had longer operative times compared with surgeons in the unilateral open procedure (43.8±13.4 min vs. 34.5±16.3 min, P<0.001), in the unilateral laparoscopic procedure (46.9±16.6 min vs. 41.7±18.7 min, P<0.001) and higher total costs in the unilateral open procedure (€ 1007.47±238.58 vs. € 909.35±305.00, P<0.001). There were no significant differences in complication and recurrence rates between residents and surgeons. CONCLUSIONS Open-mesh hernia repair appears to be superior in costs for both uni- and bilateral groin hernias when performed by surgeons as well as residents. Residents had higher total costs and longer operation times in the unilateral open groin hernia group when compared with surgeons, yet overall complications and recurrence rates were similar in all groups suggesting that residents are sometimes more expensive and slower, but just as safe.
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Affiliation(s)
- Jelle Faessen
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands -
| | - Bob Schoemakers
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | | | - Ruben Visschers
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Anton Hoofwijk
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - Jan Stoot
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
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7
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Holleran TJ, Napolitano MA, Sparks AD, Duncan JE, Garrett M, Brody FJ. Trends and outcomes of open, laparoscopic, and robotic inguinal hernia repair in the veterans affairs system. Hernia 2021; 26:889-899. [PMID: 33909151 DOI: 10.1007/s10029-021-02419-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/15/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE Robotic inguinal hernia repair (RHR) is an evolving technique but is comparatively expensive and has yet to show superior outcomes versus open (OHR) or laparoscopic (LHR) approaches. The utilization and clinical outcomes of RHR have not been reported within the veterans affairs (VA) system. This study analyzes trends in utilization and 30-day post-operative outcomes between OHR, LHR, and RHR in veterans. METHODS This is a retrospective review of patients that underwent inguinal herniorrhaphy using the Veterans Affairs Quality Improvement Program database. Multivariable analysis of outcomes was performed adjusting for pre-operative confounding covariates between OHR, LHR, and RHR. Trends in utilization, complication rates, and operative times were also reported. RESULTS From 2008-2019, 124,978 cases of inguinal herniorrhaphy were identified: 100,880 (80.7%) OHR, 18,035 (14.4%) LHR, and 6063 (4.9%) RHR. Compared to LHR, RHR was associated with 4.94 times higher odds of complications, 100 min longer mean operative time, and 1.5 days longer median length of stay (LOS). Compared to OHR, RHR was associated with 5.92 times higher odds of complications, 57 min longer mean operative time, and 1.1 days longer median LOS. Utilization of RHR and LHR significantly increased over time. RHR complication rates decreased over time (2008: 20.8% to 2019: 3.2%) along with mean operative times (2008: 4.9 h to 2019: 2.8 h; p < 0.05). CONCLUSION While this study demonstrated inferior outcomes after RHR, the temporal trends are encouraging. This may be due to increased surgeon experience with robotics. Further prospective data will elucidate the role of RHR as this technique increases.
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Affiliation(s)
- T J Holleran
- Department of Surgery, Veterans Affairs Medical Center, 50 Irving St. NW, Washington, DC, 20422, USA.,Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - M A Napolitano
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Surgery, George Washington University Hospital, Washington, DC, USA
| | - A D Sparks
- Department of Surgery, George Washington University Hospital, Washington, DC, USA
| | - J E Duncan
- Department of Surgery, Veterans Affairs Medical Center, 50 Irving St. NW, Washington, DC, 20422, USA
| | - M Garrett
- Department of Surgery, Veterans Affairs Medical Center, 50 Irving St. NW, Washington, DC, 20422, USA
| | - F J Brody
- Department of Surgery, Veterans Affairs Medical Center, 50 Irving St. NW, Washington, DC, 20422, USA. .,Department of Surgery, George Washington University Hospital, Washington, DC, USA.
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8
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Rogers AP, Xu Y, Lidor AO. Healthcare Resource Utilization in Inguinal Hernia Repair: A Three-Year Cost Evaluation of Truven Health Marketscan Research Databases. J Surg Res 2021; 264:408-417. [PMID: 33848840 DOI: 10.1016/j.jss.2021.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/11/2021] [Accepted: 02/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inguinal hernia repair is the most commonly performed elective operation in the United States, with over 800,000 cases annually. While clinical outcomes comparing laparoscopic versus open techniques have been well documented, there is little data comparing costs associated with these techniques. This study evaluates the cost of healthcare resources during the 90-d postoperative period following inguinal hernia repair. METHODS We analyzed data from the Truven Health MarketScan Research Databases. Adult patients with an ICD-9 or CPT code for inguinal hernia repair from 2012 to 2014 were included. Patients with continuous enrollment for 6 mo prior to surgery and 6 mo after surgery were analyzed. Related healthcare service costs (readmission and/or ER visit and/or outpatient visit) were calculated by clinical classification software and generalized linear modeling was used to compare healthcare utilization between groups. RESULTS 124,582 cases were identified (open = 84,535; lap = 40,047). Index surgery cost was 41% higher in laparoscopic cases. The cost for readmission was close to $25,000 and similar between both groups, but the laparoscopic group were 12% less likely to be readmitted for surgical complications within 90-d when compared to the open group. Cost of bilateral laparoscopic repair is less than that of serial unilateral open repairs. CONCLUSION Laparoscopic inguinal hernia repair carries a higher index surgery cost than open repair. However, open repair has an increased rate of readmission. To maximize value, efforts should be directed at minimizing readmissions and improving identification of bilateral hernias at the time of initial presentation.
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Affiliation(s)
- Andrew P Rogers
- Department of Surgery, University of Wisconsin, 600 Highland Avenue MC 7375, Madison, WI 53792.
| | - Yiwei Xu
- Department of Surgery, University of Wisconsin, 600 Highland Avenue MC 7375, Madison, WI 53792
| | - Anne O Lidor
- Department of Surgery, University of Wisconsin, 600 Highland Avenue MC 7375, Madison, WI 53792
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Forester B, Attaar M, Lach M, Chirayil S, Kuchta K, Denham W, Linn JG, Haggerty SP, Carbray J, Ujiki M. Inguinal hernia mesh is safe in 1720 patients. Surg Endosc 2021; 36:1609-1618. [PMID: 33763744 DOI: 10.1007/s00464-021-08442-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is substantial media and patient interest in the safety of mesh for hernia repair. However, there is a lack of data regarding health-related quality of life (HRQOL) outcomes in patients who undergo inguinal hernia repair (IHR) with mesh. The purpose of this study is report short and long-term postoperative quality of life outcomes in patients following IHR with mesh. METHODS We analyzed outcomes of 1720 patients who underwent IHR with mesh between 2008 and 2019 at a single institution from a prospectively maintained quality database. All surgeries were performed by four board-certified surgeons. HRQOL outcomes were measured using the Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys that were administered preoperatively, 3 weeks, 6 months, 1, 2, and 5 years postoperatively. Survey responses were summarized as mean with standard deviation or frequency with percentage. Postoperative SOMS scores were compared to preoperative scores using the two-tailed paired t test with a significance level of p < 0.05. RESULTS One (0.1%) patient experienced a mesh infection postoperatively. In terms of complications, 159 (9.2%) developed a seroma, 31 (1.8%) a hematoma, and 36 (2.1%) patients experienced a recurrence. SOMS Pain Impact, SOMS Pain Quality, and SOMS Pain visual analog scale at 3 weeks, 6 months, 1 year, 2 years, and 5 years were all improved from preoperative (all p < 0.05). At 5 years postoperatively, only 3.9%, 3.2%, and 3.1% of patients reported severe or disabling sensation of mesh, pain, and movement limitations, respectively. CONCLUSION Inguinal hernia repair with mesh results in a low rate of complications. A minority of patients had severe or disabling symptoms at 5-year follow-up and generally reported improvements in pain impact and quality in long-term follow-up.
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Affiliation(s)
- Beau Forester
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Mikhail Attaar
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Maya Lach
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Sebastian Chirayil
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Kristine Kuchta
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Woody Denham
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - John G Linn
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Stephen P Haggerty
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - JoAnn Carbray
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Michael Ujiki
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA.
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GOMES CA, GOMES FC, PODDA M, BRAGA APF, RIBEIRO SC, VAZ LF. LIECHTENSTEIN VERSUS CORREÇÃO DE HÉRNIA LAPAROSCÓPICA TRANSABDOMINAL PRÉ-PERITONEAL (TAPP): UM ESTUDO COMPARATIVO PROSPECTIVO COM FOCO NOS RESULTADOS PÓS-OPERATÓRIOS EM UMA UNIDADE DE CIRURGIA GERAL. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2021; 34:e1642. [PMID: 35107504 PMCID: PMC8846489 DOI: 10.1590/0102-672020210002e1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/01/2021] [Indexed: 12/01/2022]
Abstract
Three surgical techniques for inguinal hernia repair are currently validated. Few
studies have compared results among Lichtenstein and transabdominal
preperitoneal (TAPP) laparoscopic approach obtained at an early step of the
learning curve.
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11
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Takayama Y, Kaneoka Y, Maeda A, Takahashi T, Uji M. Laparoscopic transabdominal preperitoneal repair versus open mesh plug repair for bilateral primary inguinal hernia. Ann Gastroenterol Surg 2020; 4:156-162. [PMID: 32258981 PMCID: PMC7105845 DOI: 10.1002/ags3.12314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/25/2019] [Accepted: 12/28/2019] [Indexed: 11/23/2022] Open
Abstract
AIM A few studies comparing laparoscopic and open techniques have reported that open repair with mesh is the optimal operation for unilateral primary hernia. The aim of this study is to compare the outcomes of laparoscopic transabdominal preperitoneal repair (TAPP) versus open mesh plug repair (MP) for bilateral primary inguinal hernia. METHODS This was a retrospective study of 107 patients with bilateral primary inguinal hernia between January 2008 and December 2016. Of these patients, 49 underwent TAPP and 58 underwent MP. The surgical outcomes and the long-term outcomes using a questionnaire were compared between TAPP and MP. RESULTS In the TAPP group, the operation time was significantly longer (103 vs 91 minutes; P = .019). The postoperative complication rate was not significantly different between the two groups. One patient (1.0%) in the TAPP group and five patients (4.3%) in the MP group suffered recurrence (P = .30). Postoperative groin pain was not significantly different (14% in the TAPP group vs 31% in the MP group; P = .065), but more patients required analgesics in the MP group (4.1% vs 17%; P = .036). The long-term outcomes, according to a questionnaire, were not significantly different between the two groups. The median follow-up period was 22 (range, 0.4-52) months in the TAPP group and 40 (range, 0.5-108) months in the MP group (P < .001). CONCLUSION TAPP for bilateral primary inguinal hernia achieved better results than MP relative to postoperative pain and the use of medication for pain relief without increasing the complication and recurrence rates.
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Affiliation(s)
| | - Yuji Kaneoka
- Department of SurgeryOgaki Municipal HospitalOgaki‐shiJapan
| | - Atsuyuki Maeda
- Department of SurgeryOgaki Municipal HospitalOgaki‐shiJapan
| | | | - Masahito Uji
- Department of SurgeryOgaki Municipal HospitalOgaki‐shiJapan
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12
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Richmond BK, Totten C, Roth JS, Tsai J, Madabhushi V. Current strategies for the management of inguinal hernia: What are the available approaches and the key considerations? Curr Probl Surg 2019; 56:100645. [PMID: 31581983 DOI: 10.1016/j.cpsurg.2019.100645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bryan K Richmond
- Division of General Surgery, West Virginia University - Charleston Division, Charleston, WV.
| | - Crystal Totten
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, University of Kentucky, Lexington, KY
| | - John Scott Roth
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Center for Advanced Training and Simulation, University of Kentucky, Lexington, KY
| | - Jonathon Tsai
- Charleston Area Medical Center, West Virginia University - Charleston Division, Charleston, WV
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Khoraki J, Gomez PP, Mazzini GS, Pessoa BM, Browning MG, Aquilina GR, Salluzzo JL, Wolfe LG, Campos GM. Perioperative outcomes and cost of robotic-assisted versus laparoscopic inguinal hernia repair. Surg Endosc 2019; 34:3496-3507. [PMID: 31571036 DOI: 10.1007/s00464-019-07128-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/17/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Utilization of robotic-assisted inguinal hernia repair (IHR) has increased in recent years, but randomized or prospective studies comparing outcomes and cost of laparoscopic and Robotic-IHR are still lacking. With conflicting results from only five retrospective series available in the literature comparing the two approaches, the question remains whether current robotic technology provides any added benefits to treat inguinal hernias. We aimed to compare perioperative outcomes and costs of Robotic-IHR versus laparoscopic totally extraperitoneal IHR (Laparoscopic-IHR). METHODS Retrospective analysis of consecutive patients who underwent Robotic-IHR or Laparoscopic-IHR at a dedicated MIS unit in the USA from February 2015 to June 2017. Demographics, anthropometrics, the proportion of bilateral and recurrent hernias, operative details, cost, length of stay, 30-day readmissions and reoperations, and rates and severity of complications were compared. RESULTS 183 patients had surgery: 45 (24.6%) Robotic-IHR and 138 (75.4%) Laparoscopic-IHR. There were no differences between groups in age, gender, BMI, ASA class, the proportion of bilateral hernias and recurrent hernias, and length of stay. Operative time (Robotic-IHR: 116 ± 36 min, vs. Laparoscopic-IHR: 95±44 min, p < 0.01), reoperations (Robotic-IHR: 6.7%, vs. Laparoscopic-IHR: 0%, p = 0.01), and readmissions rates were greater for Robotic-IHR. While the overall perioperative complication rate was similar in between groups (Robotic-IHR: 28.9% vs. Laparoscopic-IHR: 18.1%, p = 0.14), Robotic-IHR was associated with a significantly greater proportion of grades III and IV complications (Robotic-IHR: 6.7% vs. Laparoscopic-IHR: 0%, p = 0.01). Total hospital cost was significantly higher for the Robotic-IHRs ($9993 vs. $5994, p < 0.01). The added cost associated with the robotic device itself was $3106 per case and the total cost of disposable supplies was comparable between the 2 groups. CONCLUSIONS In the setting in which it was studied, the outcomes of Laparoscopic-IHR were significantly superior to the Robotic-IHR, at lower hospital costs. Laparoscopic-IHR remains the preferred minimally invasive surgical approach to treat inguinal hernias.
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Affiliation(s)
- Jad Khoraki
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Pedro P Gomez
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Guilherme S Mazzini
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Bernardo M Pessoa
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Matthew G Browning
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Gretchen R Aquilina
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jennifer L Salluzzo
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Luke G Wolfe
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Guilherme M Campos
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
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14
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Callahan ZM, Donovan K, Su BS, Kuchta K, Carbray J, Linn JG, Denham W, Haggerty SP, Joehl RJ, Ujiki MB. Laparoscopic inguinal hernia repair after prostatectomy: Evaluating safety, efficacy, and efficiency. Surgery 2019; 166:607-614. [PMID: 31375319 DOI: 10.1016/j.surg.2019.04.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/07/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND For many surgeons, a prior prostatectomy is considered a contraindication to laparoscopic totally extraperitoneal hernia repair. This study aims to evaluate the safety, efficacy, and efficiency of totally extraperitoneal in these patients. METHODS This is a review of a prospectively collected hernia database evaluating patients who underwent totally extraperitoneal repair between October 2009 and March 2018. Patients with prior prostatectomy were matched to controls without prior prostatectomy. Secondary analysis compared the case group to patients who underwent open hernia repair. RESULTS In the study, 1,751 patients underwent laparoscopic totally extraperitoneal repair. Thirty patients with a prior prostatectomy were matched to 90 controls. Operative duration was greater in the prostatectomy group (56 vs 36 minutes, P < .0001) and more peritoneal tears occurred (40% vs 12%, P = .002). Duration of stay, return to activity, complications, and rates of recurrence and chronic pain were equivalent. When compared with prior prostatectomy patients who underwent open hernia repair, the laparoscopic totally extraperitoneal group had equivalent rates of complications and outcomes with a faster return to activities of daily living (3 vs 7 days P = .007). CONCLUSION Despite a more difficult dissection, laparoscopic totally extraperitoneal repair in patients with prior prostatectomy is safe, efficacious, and efficient. In addition, totally extraperitoneal offers similar outcomes to open repair with a quicker recovery in this patient population.
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Affiliation(s)
- Zachary M Callahan
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
| | - Kara Donovan
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - Bailey S Su
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - JoAnn Carbray
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - John G Linn
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - Woody Denham
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | | | - Raymond J Joehl
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - Michael B Ujiki
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
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15
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Effects of totally extraperitoneal and lichtenstein hernia repair on men's sexual function and quality of life. Surg Endosc 2019; 34:1103-1111. [PMID: 31161289 DOI: 10.1007/s00464-019-06857-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In the literature, there have been scant studies that compare the effects of totally extraperitoneal (TEP) and Lichtenstein hernia (LH) repairs on men's sexual function and quality of life. Our aim in this study was to study the sexual function of men after TEP and LH repair according to SF 36 (Health Survey Scoring Demonstration) and IIEF (The International Index of Erectile Function). METHODS A total of 176 men with unilateral inguinal hernia were randomized into two groups. Group T (n = 88) received TEP hernia repair, and Group L (n:88) received LH repair. Patients' demographics and perioperative findings were recorded. For all patients, the preoperative as well as postoperative 7th, 30th and 90th day SF 36 and IIEF were recorded. RESULTS A total of 176 operations consisting of 88 TEP and 88 LH repairs were evaluated. There were no differences in demographics, hernia type, and complications except for body mass index (BMI). The operative time was higher in Group T (29.6 ± 5.8 vs. 43.5 ± 5.7 min; p = 0.001). The averages of the SF 36-Vitality and Social Function for Postoperative (PO) 30th day scores were higher in Group T. The averages of the SF 36-Bodily Pain, General Health, Physical Role, Emotional Role for PO 7-30th days SF36- Mental Health for PO 7th day and SF 36 Physical Function for PO 30-90th days scores were statistically higher in Group T. The averages of the IIEF- Erectile Function for PO 30th day, IIEF- Orgasmic Function, Sexual Desire, Intercourse Satisfaction, and Intercourse Satisfaction for PO 7th and 30th days scores were higher in Group T. CONCLUSIONS TEP and LH repairs have similar results for recurrence, complications, and hospital stay; otherwise, TEP repair yields better results than the LH repair in the postoperative course at the 7th and 30th day evaluation, concerning sexual function and quality of life, but this benefit is no longer apparent at the 90th day. Although the short-term differences were statistically significant, they were moderate and might have a limited impact from the clinical point of view.
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16
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Rana G, Armijo PR, Khan S, Bills N, Morien M, Zhang J, Oleynikov D. Outcomes and impact of laparoscopic inguinal hernia repair versus open inguinal hernia repair on healthcare spending and employee absenteeism. Surg Endosc 2019; 34:821-828. [PMID: 31139991 DOI: 10.1007/s00464-019-06835-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study compares the impact of open (OIHR) versus laparoscopic (LIHR) inguinal hernia repair on healthcare spending and postoperative outcomes. METHODS The TRUVEN database was queried using ICD9 procedure codes for open, laparoscopic, and robotic-assisted IHR, from 2012 to 2013. Patients > 18 years of age and continuously enrolled for 12 months postoperatively were included. Demographics, patient comorbidities, postoperative complications, pain medication use, length of hospital stay, missed work hours, postoperative visits, and overall expenditure were collected, and assessed at time of surgery and at 30-, 60-, 90-, 180-, and 365-days postoperatively. Statistical analysis was conducted using SAS, with α = 0.05. RESULTS 66,116 patients were included (LIHR: N = 23,010; OIHR: N = 43,106). Robotic-assisted procedures were excluded due to small sample size (N = 61). The largest demographic was males between 55 and 64 years. LIHR had fewer surgical wound complications than OIHR (LIHR: 0.3%; OIHR: 0.5%, p = 0.007), less utilization of pain medication (LIHR: 23.3%; OIHR: 28.5%; p < 0.001), and fewer outpatient visits. In the 90-day postoperative period, LIHR had significantly fewer missed work hours (LIHR: 12.1 ± 23.2 h; OIHR: 12.9 ± 26.7 h, p = 0.023). LIHR had higher postoperative urinary complications (LIHR: 0.2%; OIHR: 0.1%; p < 0.001), consistent with the current literature. LIHR expenditures ($15,030 ± $25,906) were higher than OIHR ($13,303 ± 32,014), p < 0.001. CONCLUSIONS The results highlight the benefits of laparoscopic repair with regard to surgical wound complications, postoperative pain, outpatient visits, and missed work hours. These improved outcomes with respect to overall healthcare spending and employee absenteeism support the paradigm shift toward laparoscopic inguinal hernia repairs, in spite of higher overall expenditures.
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Affiliation(s)
- Gurteshwar Rana
- Department of Surgery, General Surgery, University of Nebraska Medical Center, Omaha, NE, 68198-6246, USA
| | | | - Shariq Khan
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nathan Bills
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Marsha Morien
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jianying Zhang
- Minimally Invasive Therapies Group, Medtronic, Mansfield, MA, USA
| | - Dmitry Oleynikov
- Department of Surgery, General Surgery, University of Nebraska Medical Center, Omaha, NE, 68198-6246, USA. .,Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, NE, USA.
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17
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Mongelli F, Ferrario di Tor Vajana A, FitzGerald M, Cafarotti S, Lucchelli M, Proietti F, Di Giuseppe M, La Regina D. Open and Laparoscopic Inguinal Hernia Surgery: A Cost Analysis. J Laparoendosc Adv Surg Tech A 2019; 29:608-613. [PMID: 30807244 DOI: 10.1089/lap.2018.0805] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: In the treatment of inguinal hernias, there is little hard evidence concerning the economic reimbursement in the diagnosis-related group (DRG) era. Factors that affect whether a hospital may earn or lose financially depending on open or laparoscopic approach is still underexplored. The aim of this study was to provide a reliable analysis of in-hospital costs and reimbursements in inguinal hernia surgery. Methods: This retrospective study analyzed the 1-year experience in inguinal hernia repair in patients undergoing open Lichtenstein (OL), laparoscopic totally extraperitoneal unilateral (UTEP), or bilateral (BTEP) hernia repair. Demographics, results, costs, and DRG-based reimbursements were recorded and analyzed. Results: During the study period, 39 patients underwent OL, 82 patients UTEP, and 16 patients BTEP. The average total cost amounted to 4126 EUR in OL, 5134 EUR in UTEP, and 7082 EUR in BTEP groups (P < .001). The hospital reimbursement amounted to 5486 EUR, 5252 EUR, and 6555 EUR in the OL, UTEP, and BTEP groups, respectively (P < .001). Finally, the mean hospital earnings were 1360 EUR, 118 EUR, and -527 EUR for each patient in OL, UTEP, and BTEP, respectively (P < .001). Conclusions: In-hospital costs were higher in UTEP and BTEP as compared with OL. The DRG-based reimbursement provided adequate compensation for patients with unilateral inguinal hernia, whereas hospital earnings were profitable in OL group only, and led an overall financial loss in the BTEP group. Surgeons should be conscious that clinical advantages of the laparoscopic approach are not adequately compensated for, from an economic point of view.
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Affiliation(s)
- Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | | | - Maurice FitzGerald
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Stefano Cafarotti
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Massimo Lucchelli
- Department of Medical Controlling, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Francesco Proietti
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Matteo Di Giuseppe
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
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18
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Rajapaksha K, Silva LJCM, Herath A, D Anandappa MJ, Bandara TMIG. Impact of institutional hernia programme on guideline conformity of surgical approach and mode of anesthesia for inguinal hernia repair and analysis of the outcomes. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2019. [DOI: 10.4103/ijawhs.ijawhs_14_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Pavlosky KK, Vossler JD, Murayama SM, Moucharite MA, Murayama KM, Mikami DJ. Predictors of laparoscopic versus open inguinal hernia repair. Surg Endosc 2018; 33:2612-2619. [PMID: 30374789 DOI: 10.1007/s00464-018-6557-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Inguinal hernia repair (IHR) is among the most common general surgery procedures. Multiple studies have examined costs and benefits of laparoscopic approach versus open repair. This study aimed to identify patient, surgeon, and hospital demographic predictors of laparoscopic versus open IHR. METHODS We conducted a retrospective analysis of 342,814 IHRs (241,669 open; 101,145 laparoscopic) performed in adults (age ≥ 18) from 2010 to 2015 using the Premier Hospital Database. Multivariate logistic regression was used to estimate the adjusted odds ratio of an IHR being laparoscopic versus open with respect to several demographic variables. RESULTS The odds of an IHR being laparoscopic increased from 2010 to 2015. A laparoscopic procedure was more likely in patients who were < age 65 (OR 1.29, CI 1.24-1.31, p < 0.0001), male (OR 1.31, CI 1.27-1.34, p < 0.0001), privately insured (OR 1.36, CI 1.33-1.40, p < 0.0001), and neither white, black, nor Hispanic (OR 1.11, CI 1.09-1.14, p < 0.0001). The likelihood of a procedure being laparoscopic decreased 13% with each one-unit increase in Charlson comorbidity index value (OR 0.88, CI 0.87-0.89, p < 0.0001). Surgeons were more likely to perform a laparoscopic procedure if they had larger annual IHR caseloads (≥ 45/year; OR 1.57, CI 1.53-1.60, p < 0.0001), and operated at large hospitals (> 500 beds; OR 1.36, CI 1.33-1.39, p < 0.0001) in New England (OR 2.38, CI 2.29-2.47, p < 0.0001). Non-predictors of a laparoscopic procedure included urban/rural hospital location (OR 1.02, CI 0.10-1.05, p = 0.06) and hospital teaching status (OR 1.01, CI 0.99-1.03, p = 0.2084). CONCLUSIONS Use of laparoscopic IHR is increasing. Patient age, gender, race, and insurance type, as well as surgeon annual volume, hospital size, and hospital region were predictors of a laparoscopic procedure. Further studies are needed to explain and remedy underlying differences impacting these predictors.
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Affiliation(s)
- K Keano Pavlosky
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - John D Vossler
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, 1356 Lusitana St., Sixth Floor, Honolulu, HI, 96813, USA
| | | | | | - Kenric M Murayama
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, 1356 Lusitana St., Sixth Floor, Honolulu, HI, 96813, USA
| | - Dean J Mikami
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, 1356 Lusitana St., Sixth Floor, Honolulu, HI, 96813, USA.
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20
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Sunamak O, Donmez T, Yildirim D, Hut A, Erdem VM, Erdem DA, Ozata IH, Cakir M, Uzman S. Open mesh and laparoscopic total extraperitoneal inguinal hernia repair under spinal and general anesthesia. Ther Clin Risk Manag 2018; 14:1839-1845. [PMID: 30319265 PMCID: PMC6171754 DOI: 10.2147/tcrm.s175314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Mesh placement is the main standard in repair of inguinal hernia, and laparoscopic repair is the standard of care via spinal, epidural, or combined anesthesia. Here, we compared open and laparoscopic total extraperitoneal (TEP) repairs under general (GA) and spinal anesthesia (SA). METHODS Inguinal hernia patients (n=440) were analyzed retrospectively. There were four groups: Group 1 was TEP under GA (TEP-GA) (n=111); Group 2 was open mesh repair (OM) under SA (n=116) (OM-SA); Group 3 was open mesh repair under GA (n=117) (OM-GA); Group four was TEP under SA (n=96) (TEP-SA). The age, body mass index, duration of operation, hospital stay, postoperative Visual Analog Scale scores, recurrence, postoperative pain, urinary retention, headache, and patient satisfaction were all recorded. RESULTS There was no significant difference in terms of hypotension, vomiting, seroma and scrotal edema, recurrence, and wound infection incidence between the groups. However, the operation duration, hospital stay period, headache, urinary retention, postoperative Visual Analog Scale scores, chronic pain, and patient satisfaction showed significant differences between groups. CONCLUSION Laparoscopic TEP hernia repair is a safe and effective method along with its advantages of shorter hospital stay, less recurrence, less postoperative pain, higher patient satisfaction, and similar postoperative complication rates. SA has the disadvantage of higher incidence of headache and urinary retention compared to GA.
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Affiliation(s)
- Oguzhan Sunamak
- Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey,
| | - Turgut Donmez
- Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Dogan Yildirim
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Adnan Hut
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Vuslat Muslu Erdem
- Department of Anesthesiology, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Duygu Ayfer Erdem
- Department of Anesthesiology, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Ibrahim Halil Ozata
- Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Mikail Cakir
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sinan Uzman
- Department of Anesthesiology, Haseki Training and Research Hospital, Istanbul, Turkey
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21
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Madenci AL, Wolf LL, Jiang W, Koehlmoos TP, Learn PA, Haider AH, Smink DS. Contemporary Factors Associated with the Use of Laparoscopy for Inguinal Hernia Repair Among Department of Defense Beneficiaries. Mil Med 2018; 183:e420-e426. [PMID: 29635522 DOI: 10.1093/milmed/usy029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/29/2017] [Accepted: 02/08/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The factors that contribute to variation in utilization of laparoscopic inguinal hernia repair are unknown. We sought to determine the current usage patterns of laparoscopic and open surgery in the elective repair of uncomplicated unilateral inguinal hernia in a large population with universal health care coverage comprised of Department of Defense (DoD) beneficiaries. MATERIALS AND METHODS The DoD Military Health System Data Repository (MDR) tracks health care delivered to a universally insured population of active/reserve/retired members of the U.S. Armed Services and their dependents. The MDR was queried for elective unilateral inguinal hernia repair among adult patients between 2008 and 2014. The primary outcome was laparoscopic (vs. open) approach to hernia repair. We conducted univariable and multivariable analyses of patient- and systems-level factors associated with approach to inguinal hernia repair. This research was approved by our institutional review board prior to commencement of the study and need for informed consent was waived given the design of this study. RESULTS Among 37,742 elective uncomplicated unilateral inguinal hernia repairs, 35% (n = 13,114) were performed laparoscopically. In 2014, 40% of inguinal hernia repairs were performed laparoscopically, compared with 27% of repairs in 2008 (P < 0.01). In multivariable analysis, laparoscopic hernia repair was more likely for male patients (OR = 1.38, 95% CI = 1.23-1.54, P < 0.01), military (vs. civilian) institutions (OR = 1.34, 95% CI = 1.28-1.41, P < 0.01), active-duty officers (vs. active-duty enlisted; OR = 1.21, 95% CI = 1.12-1.30, P < 0.01), and more recent year of surgery (P < 0.01). Laparoscopic repair was significantly less likely among patients with greater than one comorbidity (vs. none; OR = 0.68, 95% CI = 0.61-0.76, P < 0.01). CONCLUSION In a large, universally insured population of military service members and their dependents, laparoscopic inguinal repair is increasingly used and was preferred over open repair for younger, healthier, active-duty patients and those treated within the military (vs. non-military) care system.
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Affiliation(s)
- Arin L Madenci
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA.,Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard Medical School, One Brigham Circle, 1620 Tremont St, Boston, MA
| | - Lindsey L Wolf
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA.,Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard Medical School, One Brigham Circle, 1620 Tremont St, Boston, MA
| | - Wei Jiang
- Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard Medical School, One Brigham Circle, 1620 Tremont St, Boston, MA
| | - Tracey P Koehlmoos
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
| | - Peter A Learn
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
| | - Adil H Haider
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA.,Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard Medical School, One Brigham Circle, 1620 Tremont St, Boston, MA
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA.,Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard Medical School, One Brigham Circle, 1620 Tremont St, Boston, MA
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22
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Kolachalam R, Dickens E, D'Amico L, Richardson C, Rabaza J, Gamagami R, Gonzalez A. Early outcomes of robotic-assisted inguinal hernia repair in obese patients: a multi-institutional, retrospective study. Surg Endosc 2017. [PMID: 28646321 DOI: 10.1007/s00464-017-5665-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Minimally invasive inguinal hernia repair (IHR) in general and particularly in obese patients has not been widely adopted, potentially due to the perceived technical challenges and the well-documented learning curve associated with laparoscopic repair. Outcomes in robotic-assisted IHR in obese (BMI ≥ 30 kg/m2) patients have not been described and warrant study. METHODS Seven surgeons conducted a multicenter retrospective chart review of their early robotic-assisted IHR (RHR) cases and compared them with their open IHR (OHR) cases. Demographics, operative characteristics, and perioperative morbidity were compared for unadjusted and propensity-matched populations. RESULTS 651 robotic-assisted cases and 593 open cases were collected. The outcomes of 148 RHRs to 113 OHRs in obese patients were compared. For obese populations-whether unadjusted (robotic-assisted, n = 148; open, n = 113) or matched (1:1) (robotic-assisted, n = 95; open, n = 93)-the robotic-assisted and open cohorts were comparable in terms of demographics and baseline characteristics. Significantly higher percentages of OHR patients experienced postoperative complications post-discharge (unadjusted: 11.5% vs. 2.7%, p = 0.005; and matched: 10.8% vs. 3.2%, p = 0.047). More concomitant procedures and bilateral repairs were conducted in obese RHR patients than in obese OHR patients (unadjusted 29.7% vs. 16.8%, p = 0.019; and unadjusted 35.1% vs. 11.5%, p < 0.0001-respectively). Prior laparoscopic IHR experience did not affect 30-day outcomes. CONCLUSIONS Obese patients who undergo RHR have a lower rate of postoperative complications compared to obese patients who undergo OHR. Previous laparoscopic IHR experience, more bilateral repairs, and more concomitant procedures were not associated with increased complications in RHR patients. These outcomes may facilitate increased adoption of minimally invasive IHR approaches in the obese population.
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Affiliation(s)
- Ramachandra Kolachalam
- Department of Surgery, Providence-Providence Park Hospital, 26850, Providence Pkwy, Suite 460, Novi, MI, 48374, USA.
| | - Eugene Dickens
- Hillcrest Medical Center and Oklahoma Physician Group, Tulsa, OK, USA
| | - Lawrence D'Amico
- ValleyCare Health System of Ohio, Trumbull Memorial Hospital, Warren, OH, USA
| | | | - Jorge Rabaza
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
| | | | - Anthony Gonzalez
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
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23
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Thiels CA, Holst KA, Ubl DS, McKenzie TJ, Zielinski MD, Farley DR, Habermann EB, Bingener J. Gender disparities in the utilization of laparoscopic groin hernia repair. J Surg Res 2016; 210:59-68. [PMID: 28457341 DOI: 10.1016/j.jss.2016.10.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/14/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Clinical treatment guidelines have suggested that laparoscopic hernia repair should be the preferred approach in both men and women with bilateral or recurrent elective groin hernias. Anecdotal evidence suggests, however, that women are less likely to undergo a laparoscopic repair than men, and therefore, we aimed to delineate if these disparities persisted after controlling for patient factors and comorbidities. MATERIALS AND METHODS The American College of Surgeons National Surgical Quality Improvement Project data were abstracted for all elective groin hernia repairs between 2005 and 2014. Univariate analysis was used to compare rates of laparoscopic surgery between men and women. Multivariable analysis was performed, controlling for patient demographics, preoperative comorbidities, and year of surgery. RESULTS Over the 10-y period, 141,490 patients underwent elective groin hernia repair, of which 13,325 were women (9.4%). The rate of general anesthesia utilization was high in both men (81.3%) and women (77.2%) with 75.1% of open repairs being performed under general anesthesia. Overall, 20.2% of women underwent laparoscopic repair compared with 28.0% of men (P < 0.01). Women tended to be older, had a lesser body mass index, and slightly greater American Anesthesia Association (all P < 0.05). On multivariable regression, women had decreased odds of undergoing a laparoscopic approach compared with men (odds ratio: 0.70; 95% confidence interval, 0.67-0.73, P < 0.01). CONCLUSIONS In the elective setting, women were less likely to undergo laparoscopic repair of groin hernias than men. Although we are unable to ascertain underlying causes for these gender disparities, these data suggest that there remains a disparity in the management of groin hernias in women.
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Affiliation(s)
- Cornelius A Thiels
- Department of Surgery, Mayo Clinic, Rochester, Minnesota; Health Services Research, The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
| | | | - Daniel S Ubl
- Health Services Research, The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | | | - David R Farley
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth B Habermann
- Health Services Research, The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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Froylich D, Haskins IN, Aminian A, O’Rourke CP, Khorgami Z, Boules M, Sharma G, Brethauer SA, Schauer PR, Rosen MJ. Laparoscopic versus open inguinal hernia repair in patients with obesity: an American College of Surgeons NSQIP clinical outcomes analysis. Surg Endosc 2016; 31:1305-1310. [DOI: 10.1007/s00464-016-5112-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
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25
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The effect of tobacco use on outcomes of laparoscopic and open inguinal hernia repairs: a review of the NSQIP dataset. Surg Endosc 2016; 31:917-921. [PMID: 27351659 DOI: 10.1007/s00464-016-5055-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND As the effort to reduce postoperative morbidity and mortality continues, the search for modifiable patient risk factors to reduce complications is ongoing. Tobacco use is associated with impaired wound healing, but its effect on inguinal hernia repair has not been studied in a large population. An ACS-NSQIP dataset was used to evaluate the effect of tobacco use on outcomes of inguinal hernia repairs. METHODS The ACS-NSQIP dataset was queried for patients who underwent open or laparoscopic inguinal hernia repairs, by primary procedure CPT codes, between years 2009-2012. Tobacco use was registered, as defined by the ACS-NSQIP, in two ways: current smoking (within the past 12 months), or history of smoking (having ever smoked). Univariate and multivariate analyses were used to investigate outcome variables for 30-day morbidity by type of smoking status, while adjusting for preoperative risk factors. RESULTS During the study period, 90,162 patients underwent inguinal hernia repair. 76 % of the cases were open compared to 24 % laparoscopic. The population was overwhelmingly male, 91 %, compared to 9 % female. The average age of patients was 42.5 years. Of the available data (69 % of patients), 38.5 % had a history of smoking. 18 % had smoked within the 12 months prior to surgery (current smokers). Their average number of pack years was 27.2 (SD 24.0) compared to 4.5 pack years (SD 14.7) for those who had not smoked 12 months prior to surgery (historical smokers). Using Fisher's exact test, having ever smoked was found to be significantly associated with pneumonia (p = 0.0008) and return to the operating room (p = 0.010). This relationship held when preoperative variables were controlled for using logistic regression (pneumonia, p = 0.002; return to the operating room, p = 0.002). When preoperative variables were controlled for and logistic regression was performed for current smokers, there was also a significant association with pneumonia (p = 0.005) and return to the operating room (p = 0.01). CONCLUSION Current smoking status is a modifiable risk of patients undergoing laparoscopic and open inguinal hernia repair. Failure to quit smoking prior to surgical repair is associated with complications like pneumonia and return to the operating room.
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