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Hemberg A, Landén J, Montgomery A, Holmberg H, Nordin P. Management of groin hernia repair in Sweden: A register-based comparative analysis of public and private healthcare providers. Scand J Surg 2024; 113:211-218. [PMID: 38590013 DOI: 10.1177/14574969241242312] [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] [Indexed: 04/10/2024]
Abstract
BACKGROUND Swedish healthcare is in a period of transition with an expanding private sector. This study compares quality of outcome after groin hernia repair performed in a public or private healthcare setting. METHODS A cohort study based on data from the Swedish National Hernia Register combined with Patient-Reported Outcome Measures (PROMs) 1 year after groin hernia repair. Between September 2012 and December 2018, a questionnaire was sent to all patients registered in the hernia register 1 year after surgery. Endpoints were reoperation for recurrence, chronic pain, and patient satisfaction. RESULTS From a total of 87,650 patients with unilateral groin hernia repair, 61,337 PROM answers (70%) were received from 71 public and 28 private healthcare providers. More females, acute and recurrent cases, and patients with high American Society of Anesthesiology (ASA) scores were operated under the national healthcare system. The private sector had more experience surgeons with higher annual volume per surgeon, shorter time on waiting lists, and shorter operation times. No difference was seen in patient satisfaction. Groin hernia repair performed in a private clinic was associated with less postoperative chronic pain (OR 0.85, 95% CI 0.8-0.91) but a higher recurrence rate (HR 1.41; 95% CI 1.26-1.59) in a multivariable logistic regression analysis. CONCLUSION Despite private clinics having a higher proportion of experienced surgeons and fewer complex cases, the recurrence rate was higher, whereas the risk for chronic postoperative pain was higher among patients treated in the public sector.
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Affiliation(s)
- Anders Hemberg
- Helsingborgs lasarett Kirurgen Charlotte Yhlens gata 10 251 87 Helsingborg Sweden
| | - Jakob Landén
- Department of Surgical and Perioperative Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Agneta Montgomery
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Henrik Holmberg
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Pär Nordin
- Department of Surgical and Perioperative Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden
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Sadaka AH, O'Brien WJ, Rosenthal R, Itani KMF. Lessons learnt from the construction and implementation of a prospective ventral hernia database. Hernia 2024; 28:1121-1128. [PMID: 38551793 DOI: 10.1007/s10029-024-02986-1] [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: 11/30/2023] [Accepted: 02/08/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE The New England VA Hernia Registry was created in 2011 to prospectively collect relevant details of ventral hernia repairs, with the intention to assess and improve long term outcomes. The goal of this study is to assess registry compliance. METHODS All ventral hernia operations performed in five VA hospitals between 2011-2022 were obtained. We assessed compliance at the hospital and surgeon level. RESULTS 3,516 cases were performed. Overall compliance with registry entry was 37.5%, ranging from 10.8% to 67.2% across hospitals. At the hospital level, there was a negative correlation between average yearly hernia volume per surgeon and registry compliance (r2 = 0.53). Surgeon compliance varied within hospitals and over time. CONCLUSION Registry compliance was low and highly variable. Lack of interest, incentives, oversight, and surgeon turnover are possible factors for noncompliance. Building a registry with these factors in mind, providing timely feedback, and conducting frequent audits may improve compliance.
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Affiliation(s)
- A H Sadaka
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
- VA Boston Department of Surgery, 1400 VFW Parkway, Boston, MA, 02132, USA.
| | - W J O'Brien
- VA Boston CHOIR, 150 S. Huntington Ave, Boston, MA, 02130, USA
| | - R Rosenthal
- Department of Surgery, Yale University School of Medicine, 20 York St, New Haven, CT, 06504, USA
| | - K M F Itani
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
- VA Boston Department of Surgery, 1400 VFW Parkway, Boston, MA, 02132, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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Dahlstrand U, Melkemichel M, Österberg J, Montgomery A, de la Croix H. Female Groin Hernia Repairs in the Swedish Hernia Register 1992-2022: A Review With Updates. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11759. [PMID: 38312425 PMCID: PMC10831639 DOI: 10.3389/jaws.2023.11759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/07/2023] [Indexed: 02/06/2024]
Abstract
Introduction: Groin hernias in women is much less common than in men; it constitutes only 9% of all groin hernia operations. Historically, studies have been performed on men and the results applied to both genders. However, prospectively registered operations within national registers have contributed to new knowledge regarding groin hernias in women. The aim of this paper was to investigate and present a body of literature based upon the Swedish Hernia Register together with recent data from the register's annual report. Patients and Methods: PubMed and Embase were searched for studies based on the Swedish Hernia Register between 1992 and 2023. Based on the initial reading of abstracts, studies that presented results separately for women were selected and read. Recent data were acquired from the 2022 annual report of the Swedish Hernia Register. Results: A total of 73 studies of interest were identified. Of these, 52 included women, but only 19 presented separate results for women. Four themes emerged and were analysed further: emergency surgery and mortality, femoral hernias, the risk of reoperation for recurrence, and chronic pain following female groin hernia repairs. Discussion: Studies from the Swedish Hernia Register clearly describe that both the presentation of hernias and outcomes after repair differ significantly between the two genders. The differences that have been identified over the years have been incorporated into the national guidelines. Register data indicates that the guidelines have been implemented and are fairly well adhered to. As a result, significant improvements in outcomes regarding recurrences have been made for women with groin hernias in Sweden.
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Affiliation(s)
- Ursula Dahlstrand
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Enköping Hospital, Enköping, Sweden
| | - Maria Melkemichel
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Södertälje Hospital, Södertälje, Sweden
| | - Johanna Österberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Mora Hospital, Mora, Sweden
| | - Agneta Montgomery
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Hanna de la Croix
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Bladin O, Young N, Nordquist J, Roy J, Järnbert-Pettersson H, Sandblom G, Löfgren J. Learning curve in open groin hernia surgery: nationwide register-based study. BJS Open 2023; 7:zrad108. [PMID: 37882629 PMCID: PMC10601449 DOI: 10.1093/bjsopen/zrad108] [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: 04/29/2023] [Revised: 08/07/2023] [Accepted: 08/22/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Current recommendations regarding the number of open groin hernia repairs that surgical trainees are required to perform during their residency are arbitrarily defined and vary between different curricula. This register-based study sought to investigate the learning curve of surgeons performing open anterior mesh repair for groin hernia by assessing hernia recurrence rates, surgical complications and operating times in relation to the number of procedures performed. METHOD Nationwide data on open anterior mesh repair for groin hernia performed by surgical residents were collected from the Swedish Hernia Register between 2005 and 2020. The data were analysed in a cohort undergoing procedures carried out by surgeons performing their first registered repair as resident general surgeons. Repairs by surgeons with fewer than 30 repairs were excluded. RESULTS A total of 38 845 repairs carried out by 663 surgeons were included. Operation time decreased with increasing number of performed procedures, mean (s.d.) operation time was 79 (26) min for the first 15 procedures and 60 (23) min after 241 procedures (P <0.001). A turning point where complication rates began to decrease was seen after 60 procedures. Complication rates were 3.6 per cent (396 of 10 978) for procedures 31-60 and 2.7 per cent (157 of 5 798) for procedures 61-120 (P = 0.002). There was no significant relationship between the number of procedures performed and the rate of operation on for recurrence (P = 0.894). CONCLUSION Sixty performed procedures during surgical residency is a reasonable target for achieving competency to perform open anterior mesh repair for groin hernia safely without supervision.
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Affiliation(s)
- Olof Bladin
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Nathalie Young
- Acute and Trauma Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institute, Stockholm, Sweden
| | - Jonas Nordquist
- Department of Medicine (Huddinge), Karolinska Institute, Stockholm, Sweden
| | - Joy Roy
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institute, Stockholm, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Jenny Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Axman E, Holmberg H, Rutegård M, de la Croix H. Association between previous inguinal hernia surgery and the risk of anastomotic leakage after colorectal surgery: nationwide registry-based study. BJS Open 2023; 7:zrad076. [PMID: 37650245 PMCID: PMC10469297 DOI: 10.1093/bjsopen/zrad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Erik Axman
- The Queen Silvia Children´s Hospital, Department of Pediatric Surgery, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Holmberg
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Martin Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Hanna de la Croix
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital/Östra Hospital, Department of Surgery, Gothenburg, Sweden
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Olona C, Pereira-Rodríguez JA, Comas J, Villalobos R, Alonso V, Amador S, Bombuy E, Mitru C, Gimeno M, López-Cano M. Data quality validation of the Spanish Incisional Hernia Surgery Registry (EVEREG): pilot study. Hernia 2023; 27:665-670. [PMID: 36964455 DOI: 10.1007/s10029-023-02782-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE The Spanish Incisional Hernia Surgery Registry (EVEREG) was promoted by the Abdominal Wall Section of the Spanish Association of Surgeons, starting data collection in July 2012 and currently has more than 14,000 cases. The objective of this study was to validate the data collected through a pilot audit process. METHODS A sample of hospitals participating in the EVEREG registry since the beginning was selected. Patients registered in these centers in the 2012-2020 period were included. A stratified random sampling was carried out, with the inclusion of 10% of registered cases per center with a minimum of 20 cases per center. At each participating center, two researchers not belonging to the center undergoing the audit checked (on site or telematically) the concordance between the data in the registry and the data contained in the case history of each patient. RESULTS 330 patients have been analyzed, out of a total of 2673 registered, in 9 participating centers. The average accuracy has been 95.7%. Incorrect data 1.5% and missing data 2.3% CONCLUSION: The group of pilot hospitals from this EVERG incisional hernia surgery registry shows a very high precision of 95.7%. The confirmation of these findings in all the centers participating in the registry will make it possible to guarantee the quality of the studies made and their comparability with other similar national registries. TRIAL REGISTRATION nnTrial registration number: ClinicalTrials.gov ID:NCT03899012.
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Affiliation(s)
- C Olona
- General and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Tarragona, Spain.
| | - J A Pereira-Rodríguez
- General and Digestive Surgery Department, University Hospital Parc de Salut Mar., Barcelona, Spain
| | - J Comas
- General Surgery Department, Hospital de Sant Joan Despí Moisés Broggi., Barcelona, Spain
| | - R Villalobos
- General and Digestive Surgery Department, University Hospital Arnau de Vilanova, Lleida, Spain
| | - V Alonso
- General and Digestive Surgery Department, Hospital Dos de Maig., Barcelona, Spain
| | - S Amador
- General and Digestive Surgery Department, Hospital General de Granollers., Barcelona, Spain
| | - E Bombuy
- General and Digestive Surgery Department, Hospital de Mataró., Barcelona, Spain
| | - C Mitru
- General and Digestive Surgery Department, University Hospital Mutua de Terrassa, Barcelona, Spain
| | - M Gimeno
- General Surgery Department, University Hospital Parc de Salut Mar., Barcelona, Spain
| | - M López-Cano
- General and Digestive Surgery Department, University Hospital Vall d'Hebron., Barcelona, Spain
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