1
|
Jiang X, Sun R, Huang W, Yao J. Prospective comparison of two surgical approaches for incarcerated and strangulated inguinal hernia: preperitoneal hernioplasty through the lower abdominal median incision and laparoscope (TAPP). Updates Surg 2024:10.1007/s13304-024-01944-x. [PMID: 39014056 DOI: 10.1007/s13304-024-01944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
The optimal surgical approach of incarcerated and strangulated inguinal hernia is controversial. Retrospective studies showed that surgical approaches through lower abdominal median incision or laparoscopic are superior to the oblique inguinal incision, respectively. Whether transabdominal laparoscopic approach is superior to the lower abdominal median incision approach needs prospective research.Prospective comparative study of patients with incarcerated and strangulated groin hernia admitted to Jinshan hospital for emergency surgery from January 2018 to June 2022. They were divided into two groups according to different surgical approach. The open preperitoneal repair group (OPR) was operated through the lower abdominal median incision. Laparoscopic preperitoneal repair group (TAPP) was completed under transabdominal laparoscope. The perioperative complications and long-term results of the two groups were compared and analyzed. Eighty-two patients met the inclusion criteria, 40 in OPR group and 42 in TAPP group. Baseline data of the two groups were comparable. Thirteen cases (15.9%) of the two groups underwent intestinal resection and anastomosis. Seventy cases (90.2%) underwent the 1st stage mesh repair, including 5 cases of preperitoneal hernioplasty after intestinal resection. The average operation time of TAPP group was 13 min longer (60.7 ± 13.7 min vs 47.8 ± 19.8 min P < 0.001), and the visual analogue scale pain score at 24 h after operation was lower (3.5 ± 1.2 vs 4.4 ± 1.7 P = 0.019) than that of OPR group. There was 1 case of bladder injury (2.5%) in OPR group and 1 case of inferior abdominal artery injury (2.4%) in TAPP group. There was no difference in the rate of the 1st stage hernioplasty between the two groups. In OPR group, 2 cases (5%) extended the incision for more than 2 cm, while in TAPP group, 1 case (2.4%) converted to laparotomy. The time of hospital stay (3.2 ± 1.8 d vs 4.3 ± 2.7 d, P = 0.036) and return to normal activities (7.9 ± 2.7 d vs 11.0 ± 4.4 d, P < 0.001) were shorter in TAPP group. The rate of total postoperative complications including chronic pain, surgical-site infection, seroma, hernia recurrence and so on was 11.9% in TAPP group, which was not significantly different from 25% in OPR group (P = 0.212). There were no cases of mesh related infection and death within 30 days in both groups.TAPP is safe and feasible for the operation of acute incarcerated inguinal hernia. TAPP had better comfort and faster recovery over open preperitoneal repair for the appropriate patients with incarcerated/strangulated inguinal hernia, which can reduce acute pain, shorten hospital stay and return to normal activities earlier.
Collapse
Affiliation(s)
- Xiaoming Jiang
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
| | - Rongxun Sun
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
| | - Wenhai Huang
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
| | - Junliang Yao
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
| |
Collapse
|
2
|
Faessen JL, Stoot JHMB, Broos PPHL, Vijgen GHEJ, Reisinger KW, Bouvy ND, van Vugt R. Trans rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia repair under local anesthesia with sedation in the outpatient clinic: a feasibility study. Langenbecks Arch Surg 2024; 409:188. [PMID: 38896330 DOI: 10.1007/s00423-024-03383-z] [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: 02/26/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) is an open procedure in which the mesh is placed in the preperitoneal space and is therefore associated with less chronic post-operative inguinal pain. TREPP is primarily performed under general or spinal anesthesia, however, it is also possible to perform under sedation and local anesthesia with potentially advantages. This retrospective feasibility pilot study investigates the safety and efficiency of TREPP under local anesthesia in the outpatient clinic in comparison with Lichtenstein. METHODS Between 2019 and 2022, all patients who underwent an elective inguinal hernia repair under local anesthesia in the outpatient clinic operation theatre were assessed. 34 patients in the TREPP group and 213 patients in the Lichtenstein group were included. Outcomes were complications, operating time, theatre time, and early inguinal hernia recurrence within 8 weeks and 6 months post-operatively. RESULTS No significant differences in complications such as wound infection, hematoma, seroma, urine retention and early recurrence between TREPP and Lichtenstein were found. Post-operative pain at 8 weeks was not significantly higher after Lichtenstein (8.8% vs. 18.8%, P = 0.22). Operating time (21.0 (IQR: 16.0-27.3) minutes vs. 39.0 (IQR: 31.5-45.0) minutes, P < 0.001) and theatre time (37.5 (IQR: 30.8-42.5) minutes vs. 54.0 (IQR: 46.0-62.0) minutes, P < 0.001) was significantly shorter for TREPP. CONCLUSION This pilot study showed that TREPP appears to be feasible to perform safely under local anesthesia with comparable complication rates and substantially shorter operation time than Lichtenstein. These results justify further research with a larger study population and a longer period of follow up in order to provide firm conclusions.
Collapse
Affiliation(s)
- J L Faessen
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands.
| | - J H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| | - P P H L Broos
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| | - G H E J Vijgen
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - K W Reisinger
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R van Vugt
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| |
Collapse
|
3
|
Jain Y, Gianchandani Gyani SG, Chauhan S, Nayak K, Jain Y, Malhotra G, Rekavari SG. Comparative Analysis of Bilateral Open Inguinal Hernia Repair and Rives-Stoppa Repair: A Comprehensive Review. Cureus 2024; 16:e57431. [PMID: 38699116 PMCID: PMC11063569 DOI: 10.7759/cureus.57431] [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] [Received: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Inguinal hernias present a significant healthcare burden globally, necessitating effective surgical management. This comprehensive review evaluates two primary surgical techniques for managing bilateral inguinal hernias: bilateral open inguinal hernia and Rives-Stoppa repair. This review aims to provide insights into optimal surgical approaches through a comparative analysis of these techniques, including examining advantages, disadvantages, outcomes, and factors influencing technique selection. Bilateral open inguinal hernia repair offers simplicity and familiarity, while Rives-Stoppa repair may provide advantages such as reduced recurrence rates and postoperative complications. The findings underscore the importance of considering patient-specific factors, surgeon expertise, and hospital resources when selecting the optimal approach. Further research is warranted to conduct long-term comparative studies and explore innovations in surgical techniques and materials, ultimately enhancing patient outcomes and advancing inguinal hernia repair practices.
Collapse
Affiliation(s)
| | - Sanjeev G Gianchandani Gyani
- Minimal Access And Robotic Surgery, Anglia Ruskin University, Chelmsford, GBR
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Simran Chauhan
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Krushank Nayak
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yuvraj Jain
- Surgery, Bharti vidyapeeth medical college and hospital, Sangli, IND
| | - Geetika Malhotra
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sai Goutham Rekavari
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
4
|
Wang F, Ma B, Ma Q, Liu X. Global, regional, and national burden of inguinal, femoral, and abdominal hernias: a systematic analysis of prevalence, incidence, deaths, and DALYs with projections to 2030. Int J Surg 2024; 110:01279778-990000000-01010. [PMID: 38265437 PMCID: PMC11020045 DOI: 10.1097/js9.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/23/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Hernias, particularly inguinal, femoral, and abdominal, present a global health challenge. While the Global Burden of Disease (GBD) study offers insights, systematic analyses of hernias remain limited. This research utilizes the GBD dataset to explore hernia implications, combining current statistics with 2030 projections and frontier analysis. METHODS We analyzed data from the 2019 GBD Study, focusing on hernia-related metrics: prevalence, incidence, deaths, and disability-adjusted life years (DALYs) across 204 countries, grouped into 21 GBD regions by the SDI (SDI). Data analysis incorporated relative change calculations, Annual Percentage Change (APC), Average Annual Percentage Change (AAPC), and Joinpoint Regression Analysis. The study also employed frontier analysis and the Bayesian Age-Period-Cohort model for trend prediction up to 2030. Analyses utilized R version 4.2.3. RESULTS From 1990 to 2019, global hernia cases surged by 36%, reaching over 32.5 million, even as age-standardized rates declined. A similar pattern was seen in mortality and DALYs, with absolute figures rising but age-standardized rates decreasing. Gender data between 1990 and 2020 showed consistent male dominance in hernia prevalence, even as rates for both genders fell. Regionally, Andean Latin America had the highest prevalence, with Qatar and Bulgaria noting significant increases and decreases, respectively. Frontier analyses across 204 countries linked higher SDIs with reduced hernia prevalence. Yet, some high SDI countries, like Qatar and the UK, deviated unexpectedly. Predictions up to 2030 anticipate increasing hernia prevalence, predominantly in males, while death rates are expected to decline. DALYs, after declining, are stabilizing. CONCLUSIONS Our analysis reveals a complex interplay between socio-demographic factors and hernia trends, emphasizing the need for targeted healthcare interventions. Despite advancements, vigilance and continuous research are essential for optimal hernia management globally.
Collapse
Affiliation(s)
- Fan Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing
| | - Bangzhen Ma
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Qiuyue Ma
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing
| | - Xiaoli Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing
| |
Collapse
|
5
|
Willms AG, Schaaf S, Schwab R. Analysis of surgical quality indicators after certification as a Hernia Center. Updates Surg 2024; 76:255-264. [PMID: 36811182 PMCID: PMC10805962 DOI: 10.1007/s13304-023-01449-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
Certifications are an increasingly used tool of quality management in the health care system. The primary goal is to improve the quality of treatment due to implemented measures based on a defined catalog of criteria and standardization of the treatment processes. However, the extent to which this affects medical and health-economic indicators is unknown. Therefore, the study aims to examine the possible effects of the certification as a Reference Center for Hernia Surgery on the treatment quality and reimbursement dimensions. The observation and recording periods were defined as 3 years before (2013-2015) and 3 years after certification as a "Reference Center for Hernia Surgery" (2016-2018). Possible changes due to the certification were examined based on multidimensional data collection and analysis. In addition, the aspects of structure, process and result quality, and the reimbursement situation were reported. One thousand three hundred and nineteen cases before and one thousand four hundred and three cases after certification were included. After the certification, the patients were older (58.1 ± 16.1 vs. 64.0 ± 16.1 years, p < 0.01), had a higher CMI (1.01 vs. 1.06), and a higher ASA score (< III 86.9 vs. 85.5%, p < 0.01). The interventions became more complex (e.g., recurrent incisional hernias 0.5% vs. 1.9%, p < 0.01). The mean length of hospital stay was significantly reduced for incisional hernias (8.8 ± 5.8 vs. 6.7 ± 4.1 days, p < 0.001). The reoperation rate for incisional hernias also decreased significantly from 8.24 to 3.66% (p = 0.04). The postoperative complication rate for inguinal hernias was significantly reduced (3.1 vs. 1.1%, p = 0.002). The reimbursement of the hernia center increased by 27.6%. There were positive changes in process and outcome quality and reimbursement after the certification, which supports the effectivity of certifications in hernia surgery.
Collapse
Affiliation(s)
- Arnulf Gregor Willms
- Department of General, Visceral and Thoracic Surgery, Hernia Reference Center of the German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany.
- Department of General and Visceral Surgery, German Armed Forces Hospital, Lesserstr. 180, 22049, Hamburg, Germany.
| | - Sebastian Schaaf
- Department of General, Visceral and Thoracic Surgery, Hernia Reference Center of the German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - Robert Schwab
- Department of General, Visceral and Thoracic Surgery, Hernia Reference Center of the German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| |
Collapse
|
6
|
Peixoto N, Grobet-Jeandin E, Schoofs F, Windisch O, Iselin C, Benamran D. Long term efficacy of prosthetic inguinal herniorrhaphy concomitant with robot-assisted laparoscopic radical prostatectomy. World J Urol 2023; 41:3169-3174. [PMID: 37755521 PMCID: PMC10632196 DOI: 10.1007/s00345-023-04625-3] [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: 06/07/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
PURPOSE Patients who undergo robot-assisted laparoscopic radical prostatectomy (RARP) may present concurrent or secondary inguinal hernia (IH). Surgical repair of IH simultaneously with RARP has been reported. We aimed to assess the long-term efficacy of concurrent prosthetic IH repair with RARP. METHODS Data for consecutive patients undergoing concurrent IH repair with RARP for localized prostate cancer at our institution between 2006 and 2017 were retrospectively analysed. Patients were matched based on age, BMI, and year of surgery, with patients undergoing RARP alone. IH repair was performed with a polyester mesh. Efficacy of IH repair was the primary outcome. Patient characteristics, perioperative data, recurrence and treatment were recorded. RESULTS A total of 136 men were included, 50% treated by RARP and concurrent IH, 50% by RARP alone. Mean age was 65 years (SD 6) and mean BMI 26.8 (SD 2.5). IH was diagnosed preoperatively in 42 patients (62%) or intraoperatively in 26 patients (38%). A total 18 patients (26%) had bilateral hernias and 50 patients had unilateral hernias (right 31%, left 43%). There was no significant difference between the two groups regarding perioperative data. The herniorrhaphy added 34 min to the operative time (p < 0.001). After a mean follow-up of 106 months [SD 38], 9 patients (13%) presented recurrence of IH, with a mean time to recurrence of 43 months [SD 35]. Age was significantly associated with IH recurrence (p = 0.0007). CONCLUSION Concomitant IH repair and RARP appear to be a safe procedure with good long-term safety and efficacy, without significantly increasing morbidity.
Collapse
Affiliation(s)
- Nelson Peixoto
- Division of Urology, Geneva University Hospitals, 1211 Genève 14, Geneva, Switzerland
| | | | - Fabian Schoofs
- Division of Urology, Geneva University Hospitals, 1211 Genève 14, Geneva, Switzerland
| | - Olivier Windisch
- Division of Urology, Geneva University Hospitals, 1211 Genève 14, Geneva, Switzerland
| | - Christophe Iselin
- Division of Urology, Geneva University Hospitals, 1211 Genève 14, Geneva, Switzerland
| | - Daniel Benamran
- Division of Urology, Geneva University Hospitals, 1211 Genève 14, Geneva, Switzerland.
| |
Collapse
|
7
|
Benissan-Messan DZ, Tamer R, Pieper H, Meara M, Chen X(P. What factors impact surgical operative time when teaching a resident in the operating room. Heliyon 2023; 9:e16554. [PMID: 37251464 PMCID: PMC10220402 DOI: 10.1016/j.heliyon.2023.e16554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/27/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose Resident involvement would likely lead to prolonged operative time of a surgical case performed at academic medical centers. However, little is known about factors beneath this phenomenon. The purpose of this study was to investigate whether factors from case (procedure type, surgical case complexity, and surgical approach), teacher (attending surgeon experience and gender), and learner (resident postgraduate training year and gender) would influence operative time of surgical cases involved teaching a resident (SCT). Methods A single-institution retrospective analysis of 3 common general surgery procedures, including cholecystectomies, colectomies, and inguinal hernia, with involvement of general surgery residents between 2016 and 2020 was conducted. Surgical operative time was defined as the "cut-to-close" time from incision to completion of wound closure. Analysis of variance for continuous variables and multivariable linear regression were applied. Results A total of 4,417 eligible SCT were included. The average operative time was 114.8 ± 78.7 min. SCT with male resident involvement showed a significantly longer operative time than those with female residents (117 vs. 112, p = 0.01). Comparable operative time was observed between male and female attending surgeon cases (115.5 vs. 110.8, p = 0.15). SCT operating time decreased with increased resident training level, except for SCT with involvement of Year2 residents. SCT with Year5 residents demonstrated the lowest time to case completion (110.5 min); SCT with major complications took least time to complete (105.7 min). Univariate and multivariate analysis revealed resident training year level, resident gender, and case complexity as factors associated with significant differences in operative time. Attending surgeon experience, surgeon gender, surgical approach, and procedure type did not impact SCT operative time. Conclusion Our study findings suggest resident training level, resident gender, and case complexity are factors significantly associated with SCT operative time of cholecystectomies, colectomies, and inguinal hernia. Attending surgeons are recommended to factor them into pre-operative planning.
Collapse
Affiliation(s)
- Dathe Z. Benissan-Messan
- Division of General and Gastrointestinal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center Ohio, USA
| | - Robert Tamer
- Division of General and Gastrointestinal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center Ohio, USA
| | - Heidi Pieper
- Center for Advanced Robotic Surgery and Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center Ohio, USA
| | - Michael Meara
- Division of General and Gastrointestinal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center Ohio, USA
| | - Xiaodong (Phoenix) Chen
- Division of General and Gastrointestinal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center Ohio, USA
| |
Collapse
|
8
|
Nationwide analysis of laparoscopic groin hernia repair in Italy from 2015 to 2020. Updates Surg 2023; 75:77-84. [PMID: 36070056 PMCID: PMC9450816 DOI: 10.1007/s13304-022-01374-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/29/2022] [Indexed: 01/14/2023]
Abstract
Since its introduction, the minimally invasive treatment of groin hernias has become widely accepted as a viable alternative to open surgery. Still, the rates and reasons for its adoption vary highly among countries and the regions within a country. After almost thirty years since its introduction, its spread is still limited. The present study, conducted under the auspices of AGENAS (Italian National Agency for Regional Services), aims at giving a snapshot of the spreading of minimally invasive and robotic techniques for the treatment of groin hernia in Italy. This study is retrospective, with data covering the period from 1st January 2015 to 31st December 2020. AGENAS provided data using the operation and diagnosis codes used at discharge and reported in the International Classification of Diseases 9th revision (ICD9 2002 version). Admissions performed on an outpatient basis, i.e., without an overnight stay of at least one night in hospital, were excluded. A total of 33,925 laparoscopic hernia repairs were performed during the considered period. Overall, a slight increase in the number of procedures performed was observed from 2015 to 2019, with a mean annual change of 8.60% (CI: 6.46-10.74; p < 0.0001). The number of laparoscopic procedures dropped in 2020, and when considering the whole period, the mean annual change was - 0.98% (CI: - 7.41-5.45; p < 0.0001). Urgent procedures ranged from 335 in 2015 to 508 in 2020 referring to absolute frequencies, and from 0.87% to 9.8% in relative frequencies of overall procedures in 2017 and 2020, respectively (mean = 4.51%; CI = 3.02%-6%; p < 0.001). The most relevant observation that could be made according to our analysis was that the adoption of the laparoscopic approach knew a slow but steady increase from 2015 onward.
Collapse
|
9
|
Enodien B, Moser D, Kessler F, Taha-Mehlitz S, Frey DM, Taha A. Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12410. [PMID: 36231718 PMCID: PMC9566150 DOI: 10.3390/ijerph191912410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Medical progress is increasingly enabling more and more stationary treatment to be provided in the outpatient sector. This development should be welcomed, as healthcare costs have been rising for years. The design of efficient processes and a needs-based infrastructure enable further savings. According to international recommendations (EHS/IEHS), outpatient treatment of unilateral inguinal hernias is recommended. METHOD Data from patients in GZO Hospital Wetzikon/Zurich between 2019 and 2021 for unilateral inguinal hernia repair was included in this study (n = 234). Any over- or under-coverage correlated with one of the three treatment groups: stationary, partially stationary and patients treated in outpatients clinic. Complications and 30-day readmissions were also monitored. RESULTS Final revenue for all patients is -95.36 CHF. For stationary treatments, the mean shifts down to -575.01 CHF, for partially stationary treatments the mean shifts up to -24.73 CHF, and for patients in outpatient clinic final revenue is 793.12 CHF. This result is also consistent with the operation times, which are lowest in the outpatient clinic with a mean of 36 min, significantly longer in the partially stationary setting with 58 min, and longest in the stationary setting with 76 min. The same applies to the anesthesia times and the relevant care times by the nurses as the most important cost factors in addition to the supply and allocation costs. CONCLUSIONS We show that cost-effective elective unilateral inguinal hernia care in the outpatient clinic with profit (mean 793.12 CHF) is possible. Stationary unilateral hernia care (mean -575.01 CHF) is loss-making. Crucial factors for cost efficiency are optimized processes in the operating room (anesthesia, surgical technique and quality, operating time), as well as optimized care processes with minimal preoperative services and care times for the patient. However, at the same time, these optimizations pose a challenge to surgical and anesthesiology training and structures with high levels of preoperative and Postoperative services and pay-as-you-go costs. The complication rate is 0.91% lower than in a comparable study. The readmission within 30 days post-operation results with a positive deviation of -3.53% (stationary) and with a negative deviation of +2.29% (outpatient clinic) compared to a comparative study.
Collapse
Affiliation(s)
- Bassey Enodien
- Department of Surgery, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
| | - Dominik Moser
- Operations Management, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
- Department of Health Care Management, Technical University of Berlin, 10623 Berlin, Germany
- Department of Economics and Technology, Swiss Distance University of Applied Sciences (FFHS), 8005 Zurich, Switzerland
- School of Medicine, University of St. Gallen, 9000 St. Gallen, Switzerland
| | - Florian Kessler
- Department of Anesthesiology, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
| | - Stephanie Taha-Mehlitz
- Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4058 Basel, Switzerland
| | - Daniel M. Frey
- Department of Surgery, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Anas Taha
- Department of Surgery, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, 4123 Allschwil, Switzerland
| |
Collapse
|
10
|
Alijla SS, Binti Amran FA. Comparison of the Analgesic Effect of Subcutaneous Bupivacaine Infiltration and Intravenous Diclofenac vs. Intravenous Diclofenac Monotherapy After Inguinal Hernioplasty: A Retrospective Study. Cureus 2022; 14:e28312. [PMID: 36158363 PMCID: PMC9499650 DOI: 10.7759/cureus.28312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Postoperative pain is a significant problem encountered by patients after a surgical intervention, and there is a crucial need for effective postoperative pain control. The studies have shown that multimodal analgesia and wound infiltration are effective ways to reduce this pain and have a substantial role in the reduction of postoperative medications requirement. This study aimed to evaluate the effect of subcutaneous infiltration of bupivacaine hydrochloride and intravenous (IV) diclofenac as postoperative pain relief in adults undergoing inguinal hernia repair. Methods A single-center retrospective study included 104 patients aged 18-65 undergoing unilateral inguinal herniorrhaphy at the selected hospital. The patients were in two groups of 52 each. Group A received a 75 mg dose of IV diclofenac plus a subcutaneous injection of 10 mL of bupivacaine hydrochloride (HCl) 0.5% while Group B only received the IV diclofenac without the bupivacaine injection. The postoperative pain was assessed at one, two, three, six, and 12 hrs after the operation using the visual analog scale (VAS), which exhibited a range of pain from zero (no pain) to 10 (extreme pain). Results Of a total of 104 patients, 92% of patients were male. The patients' mean age was 36 ± 11 years, and the mean body mass index (BMI) was 22 ±3 kg/m2. American Society of Anesthesiologists physical class I was similar in both groups (90.4% versus 84.6%). Patients in Group A had significantly lower VAS pain scores at one, two, three, six, and 12 hrs after the operation and a longer emergence time than Group B (all p-values were < 0.001). Subcutaneous bupivacaine infiltration and IV diclofenac were also found to be an effective analgesic technique in open hernia repair with mesh (p-value < 0.001 for all). Conclusion Subcutaneous injection of bupivacaine combined with IV diclofenac provides superior analgesia to monotherapy intravenous diclofenac after inguinal hernia repair.
Collapse
|
11
|
Răcăreanu MM, Mogoş G, Ifrim-Predoi AM, Gogănău A, Mărgăritescu DN, Constantin C, Bică M, Marinescu D, Pătraşcu Ş, Şurlin V, Cazacu S. Lichtenstein Repair in Inguinal Hernia- A Retrospective Study on the Impact of In-Hospital Costs of Diabetes Mellitus. CURRENT HEALTH SCIENCES JOURNAL 2022; 48:211-216. [PMID: 36320872 PMCID: PMC9590365 DOI: 10.12865/chsj.48.02.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Inguinal hernia is one of the most common conditions in surgical departments and diabetes is known to have a significant impact on both patients' health and healthcare system. The current study aims to evaluate extensively the differences in costs for different subgroups of diabetic patients undergoing inguinal hernia repair in a tertiary care medical center in South-West Romania. MATERIAL AND METHODS A total number of 195 patients underwent hernia repair for primary or recurrent inguinal hernia between 2015 and 2020 and were included in the analysis. The group was divided into diabetic/non-diabetic patients and each of these subgroups was studied separately according to the presence or absence of comorbidities, sex and place of origin. RESULTS Statistically significant differences were found in the division of the age group, highlighting the fact that in diabetic patients the average age was around 74.76 years, unlike those without diabetes in which the average age was approximately 61.31 years. Another statistically significant difference was observed in the classification by hospitalization days of the group of patients with incarcerated inguinal hernia, in a sense that diabetic patients required a prolonged hospitalization by 1.5 days as opposed to non-diabetics. CONCLUSIONS The costs of hospitalization for diabetic patients undergoing hernia repair surgery were marginally higher than in non-diabetic patients, but no statistical difference could be observed between any of the costs subsets in the two patients groups.
Collapse
Affiliation(s)
| | - Gabriel Mogoş
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | | | - Alexandru Gogănău
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | | | - Cristian Constantin
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | - Marius Bică
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | - Daniela Marinescu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | - Ştefan Pătraşcu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | - Valeriu Şurlin
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | - Sergiu Cazacu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania
| |
Collapse
|
12
|
Akeel N. Short-Term Outcomes of Inguinal Hernia Repair in Older Patients: A Retrospective Review at a Tertiary Center. Cureus 2021; 13:e18170. [PMID: 34707952 PMCID: PMC8530731 DOI: 10.7759/cureus.18170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/06/2022] Open
Abstract
Objectives Although inguinal hernia (IH) repair is low-risk surgery, older patients are occasionally offered watchful waiting because of their functional status and comorbidities. This study reviewed the surgical outcomes of IH repair in older patients in comparison with outcomes in younger patients. Methods This retrospective study included all patients who had IH repair from 2010 to 2020. The primary outcomes of interest were postoperative complications and recurrence. Results A total of 262 patients underwent IH repair during the study period; 40% were ≥60 years old. One patient had a recurrence. Among the 8% of patients who had postoperative complications, groin pain was the most common one (1.9%). Female patients had a significantly higher rate of complications than male patients did (38.5% female versus 6.4% male, p<0.001). The rate of complications was also higher for emergency surgery than for elective surgery (22.6% emergency versus 6.1% elective, p<0.001), as well for patients who needed concomitant bowel resection compared with those who did not. Patients who had emergency surgery or postoperative complications had a prolonged hospital stay. Conclusions IH repair in older patients is low-risk surgery, comparable to that in younger patients. In this study, emergency surgery was more common in older than in younger patients and posed a higher risk of complications. We recommend offering elective hernia repair to older patients to avoid the higher complication rate associated with emergency repair.
Collapse
Affiliation(s)
- Nouf Akeel
- Department of Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| |
Collapse
|
13
|
Enodien B, Taha-Mehlitz S, Bachmann M, Staartjes VE, Gripp M, Staudner T, Taha A, Frey D. Analysis of Factors Relevant to Revenue Enhancement in Hernia Interventions (SwissDRG G09). Healthcare (Basel) 2021; 9:healthcare9070862. [PMID: 34356240 PMCID: PMC8306973 DOI: 10.3390/healthcare9070862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Since diagnosis-related groups (SwissDRG) were established in Switzerland in 2012, small and medium-size hospitals have encountered increasing financial troubles. Even though hernia repair operations are frequent, most hospitals fail to cover their costs with these procedures. Previous studies have focused mainly on analyzing costs and the contributing factors but less on variables that can be positively influenced. Therefore, this study aims to identify the relevant and influenceable factors for revenue growth in hernia repair surgery. Methods: Data from all patients who underwent the SwissDRG G09 surgery for a hernia in 2019 were analyzed. The contribution margin (CM4), as well as any over- or under-coverage, was correlated to case-specific costs. Results: A total of 168 patients received hernia repair surgery with the SwissDRG code G09. The average revenue/loss generated by one procedure was CHF −623.84. Procedures covered by the General Health Insurance (OKP) generated a loss of CHF −830.70 on average, whereas procedures covered by private insurance companies (VVG) generated revenue of CHF +1100 on average. Significant factors impacting the profitability of hernia repair operations were teaching during surgery (p < 0.005), the surgical operating time (p < 0.001), the total anesthesia time (p < 0.001), the number of surgeons present (p = 0.022), the insurance state of patients (p < 0.001), and the type of surgery (p < 0.01 for Lichtenstein’s procedure). Conclusions: This study reveals that hernia repair surgery performed under cost coverage by OKP is generally unprofitable. Our results further imply that the most important and influenceable factors for revenue enhancement are the quality and process optimization of the surgical department. To compensate for this deficit, hospitals should aim to increase the percentage of patients with private health insurance coverage in their procedures. Since outpatient surgery does not provide a valid alternative due to the low reimbursement by insurance companies, the cost efficiency of inpatient hernia repair needs to be increased by process optimization of the surgical department; for instance, by providing specialized hernia teams performing with shorter operation times and high quality.
Collapse
Affiliation(s)
- Bassey Enodien
- Department of Surgery, GZO Hospital, 8620 Wetzikon, Switzerland; (B.E.); (M.B.); (M.G.); (D.F.)
| | - Stephanie Taha-Mehlitz
- Clarunis University Center for Gastrointestinal and Liver Diseases, 4002 Basel, Switzerland;
| | - Marta Bachmann
- Department of Surgery, GZO Hospital, 8620 Wetzikon, Switzerland; (B.E.); (M.B.); (M.G.); (D.F.)
| | | | - Maike Gripp
- Department of Surgery, GZO Hospital, 8620 Wetzikon, Switzerland; (B.E.); (M.B.); (M.G.); (D.F.)
| | - Tobias Staudner
- Department of Visceral and Thoracic Surgery Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
| | - Anas Taha
- Department of Visceral and Thoracic Surgery Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
- Correspondence: ; Tel.: +41-52-266-4021
| | - Daniel Frey
- Department of Surgery, GZO Hospital, 8620 Wetzikon, Switzerland; (B.E.); (M.B.); (M.G.); (D.F.)
- Faculty of Medicine, University of Basel, 4001 Basel, Switzerland
| |
Collapse
|