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Khamar J, McKechnie T, Hatamnejad A, Lee Y, Huo B, Passos E, Sne N, Eskicioglu C, Hong D. The modified frailty index predicts postoperative morbidity in elective hernia repair patients: analysis of the national inpatient sample 2015-2019. Hernia 2024; 28:517-526. [PMID: 38180626 DOI: 10.1007/s10029-023-02944-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE Frailty has shown promise in predicting postoperative morbidity and mortality following hernia surgery. This study aims to evaluate the predictive capacity of the 11-item modified frailty index (mFI) in estimating postoperative outcomes following elective hernia surgery using the National Inpatient Sample (NIS) database. METHODS A retrospective analysis of the NIS from 2015 to 2019 was performed including adult patients who underwent elective hernia repair. The mFI was used to stratify patients as either frail (mFI ≥ 0.27) or robust (mFI < 0.27). The primary outcomes were in-hospital postoperative morbidity and mortality. The secondary outcomes were system-specific morbidity, length of stay (LOS), total in-hospital healthcare cost, and discharge disposition. Univariable and multivariable regressions were utilized. RESULTS In total, 14,125 robust patients and 1704 frail patients were included. Frailty was associated with an increased age (mean age 66.4 years vs. 52.6 years, p < 0.001) and prevalence of ventral hernias (51.9% vs. 44.4%, p < 0.001). Adjusted analyses demonstrated that frail patients had increased in-hospital mortality (adjusted odds ratio (aOR) 3.89, 95% CI 1.50, 10.11, p = 0.005), postoperative overall morbidity (aOR 1.98, 95% CI 1.72, 2.29, p < 0.001), postoperative LOS (adjusted mean difference (aMD) 0.78 days, 95% CI 0.51, 1.06, p < 0.001), total in-hospital healthcare costs (aMD $7562 95% CI 3292, 11,832, p = 0.001), and were less likely to be discharged home (aOR 0.61, 95% CI 0.53, 0.69, p < 0.001). CONCLUSION The mFI may be a reliable predictor of postoperative morbidity and mortality in elective hernia surgery. Utilizing this tool can aid in patient education and identifying high-risk patients who may benefit from tailored prehabilitation.
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Affiliation(s)
- J Khamar
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - T McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - A Hatamnejad
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Y Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - B Huo
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - E Passos
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of General Surgery, Department of Surgery, Hamilton General Hospital, Hamilton, ON, Canada
| | - N Sne
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of General Surgery, Department of Surgery, Hamilton General Hospital, Hamilton, ON, Canada
| | - C Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - D Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada.
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Mull HJ, Kabdiyeva A, Ndugga N, Gordon SH, Garrido MM, Pizer SD. What is the role of selection bias in quality comparisons between the Veterans Health Administration and community care? Example of elective hernia surgery. Health Serv Res 2023; 58:654-662. [PMID: 36477645 PMCID: PMC10154155 DOI: 10.1111/1475-6773.14113] [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] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the relationship between community care (CC) treatment and a postoperative surgical complication in elective hernia surgery among Veterans using multiple approaches to control for potential selection bias. DATA SOURCES AND STUDY SETTING Veterans Health Administration (VHA) data sources included Corporate Data Warehouse (VHA encounters and patient data), the Program Integrity Tool and Fee tables (CC encounters), the Planning Systems Support Group (geographic information), and the Paid file (VHA primary care providers). STUDY DESIGN Prior works suggest patient outcomes are better in VHA than in CC settings; however, these studies may not have appropriately accounted for the selection of higher-risk cases into CC. We estimated (1) a naïve logistic regression model to calculate the effect of CC setting on the probability of a complication, controlling for facility fixed effects and patient and procedure characteristics, and (2) a 2-stage model using the hernia patient's primary care provider's 1-year prior CC referral rate as the instrument. DATA COLLECTION We identified patients residing ≤40 miles from a VHA surgical facility with elective VHA or CC hernia surgery from 2018 to 2019. PRINCIPAL FINDINGS Of 7991 hernia surgeries, 772 (9.7%) were in CC. The overall complication rate was 4.2%; 286/7219 (4.0%) among VHA surgeries versus 51/5772 (6.6%, p < 0.05) in CC. We observed a 2.8 percentage point increase in the probability of postoperative complication given CC surgery (95% confidence interval: 0.7, 4.8) in the naïve model. After accounting for the VHA provider's historical rate of CC referral, we no longer observed a relationship between surgery setting and risk of postoperative complication. CONCLUSIONS After accounting for the selection of higher-risk patients to CC settings, we found no difference in hernia surgery postoperative complications between CC and VHA. Future VHA and non-VHA comparisons should account for unobserved as well as observed differences in patients seen in each setting.
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Affiliation(s)
- Hillary J. Mull
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
- Department of SurgeryBoston University School of MedicineBostonMassachusettsUSA
| | - Aigerim Kabdiyeva
- Partnered Evidence‐based Policy Resource Center (PEPReC)Department of Veterans AffairsBostonMassachusettsUSA
| | - Nambi Ndugga
- Partnered Evidence‐based Policy Resource Center (PEPReC)Department of Veterans AffairsBostonMassachusettsUSA
| | - Sarah H. Gordon
- Department of Health LawPolicy and Management, Boston University School of Public HealthBostonMassachusettsUSA
| | - Melissa M. Garrido
- Partnered Evidence‐based Policy Resource Center (PEPReC)Department of Veterans AffairsBostonMassachusettsUSA
- Department of Health LawPolicy and Management, Boston University School of Public HealthBostonMassachusettsUSA
| | - Steven D. Pizer
- Partnered Evidence‐based Policy Resource Center (PEPReC)Department of Veterans AffairsBostonMassachusettsUSA
- Department of Health LawPolicy and Management, Boston University School of Public HealthBostonMassachusettsUSA
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Lv J, Zhang Q, Zeng T, Li XF, Cui Y. Regional block anesthesia for adult patients with inguinal hernia repair: A systematic review. Medicine (Baltimore) 2022; 101:e30654. [PMID: 36197234 PMCID: PMC9509084 DOI: 10.1097/md.0000000000030654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Inguinal hernia repair (IHR) is a common surgical technique performed under regional block anesthesia (RBA). Although previous clinical trials have explored the effectiveness and safety of RBA for IHR, no systematic review has investigated its effectiveness and safety in adult patients with IHR. METHODS This systematic review searched electronic databases (PubMed, Embase, Cochrane Library, CNKI, Wangfang, and VIP) from their inception to July 1, 2022. We included all potential randomized controlled trials that focused on the effects and safety of RBA in adult patients with IHR. Outcomes included operative time, total rescue analgesics, numerical rating scale at 24 hours, occurrence rate of nausea and vomiting, and occurrence rate of urinary retention (ORUCR). RESULTS Five randomized controlled trials, involving 347 patients with IHR, were included in this study. Meta-analysis results showed that no significant differences were identified on operative time (MD = -0.20; fixed 95% confidence interval [CI], -3.87, 3.47; P = .92; I² = 0%), total rescue analgesics (MD = -8.90; fixed 95% CI, -20.36, 2.56; P = .13; I² = 28%), and occurrence rate of nausea and vomiting (MD = 0.39; fixed 95% CI, 0.13, 1.16; P = .09; I² = 0%) between 2 types of anesthesias. However, significant differences were detected in the numerical rating scale at 24 hours (MD = -1.53; random 95% CI, -2.35, -0.71; P < .001; I² = 75%) and ORUCR (MD = 0.20; fixed 95% CI, 0.05, 0.80; P = .02; I² = 0%) between the 2 management groups. CONCLUSION The results of this study demonstrated that IHR patients with RBA benefit more from post-surgery pain relief at 24h and a decrease in the ORUCR than those with CSA.
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Affiliation(s)
- Jie Lv
- Department of Anesthesiology, Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
| | - Qi Zhang
- Department of Anesthesiology, Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
| | - Ting Zeng
- Department of Anesthesiology, Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
| | - Xue-Feng Li
- Department of Anesthesiology, Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
| | - Yang Cui
- Department of Anesthesiology, Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
- *Correspondence: Yang Cui, Department of Anesthesiology, Second Affiliated Hospital of Mudanjiang Medical University, No. 15 Dongxiaoyun Street, Aimin District, Mudanjiang 157000, China (e-mail: )
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