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Maertens F, Chan PH, Prentice HA, Brill ER, Paxton EW, Mostaedi R. Female sex and ipsilateral reoperation risk following mesh-based inguinal hernia repair: a cohort study including 131,626 repairs in adults from an integrated healthcare system over a 10-year period. Hernia 2024; 28:25-31. [PMID: 37682377 DOI: 10.1007/s10029-023-02878-w] [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: 04/21/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE We sought to compare females and males for the risk of reoperation following different inguinal hernia repair approaches (open, laparoscopic, and robotic). METHODS We conducted a retrospective cohort study including all patients aged ≥ 18 who underwent first inguinal hernia repair with mesh within a US integrated healthcare system (2010-2020). Data were obtained from the system's integrated electronic health record. Multiple Cox proportional-hazards regression was used to evaluate the association between sex and risk for ipsilateral reoperation during follow-up. Analysis was stratified by surgical approach (open, laparoscopic, and robotic). RESULTS The study cohort was comprised of 110,805 patients who underwent 131,626 inguinal hernia repairs with mesh, 10,079 (7.7%) repairs were in females. After adjustment for confounders, females had a higher risk of reoperation than males following open groin hernia repair (hazard ratio [HR] = 1.98, 95% CI 1.74-2.25), but a lower reoperation risk following laparoscopic repair (HR = 0.70, 95% CI 0.51-0.97). The crude 5-year cumulative reoperation probability following robotic repair was 2.8% in males and no reoperations were observed for females. Of females who had a reoperation, 10.3% (39/378) were for a femoral hernia, while only 0.6% (18/3110) were for femoral hernias in males. CONCLUSION In a large multi-center cohort of mesh-based inguinal hernia repair patients, we found a higher risk for reoperation in females after an open repair approach compared to males. Lower risk was observed for females through a minimally invasive approach (laparoscopic or robotic) and may be due to the ability to identify an occult femoral hernia through these approaches.
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Affiliation(s)
- F Maertens
- Department of Surgery, The Permanente Medical Group, 3600 Broadway, 3rd Floor, Suite 38, Oakland, CA, 94611, USA.
| | - P H Chan
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA, USA
| | - H A Prentice
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA, USA
| | - E R Brill
- Department of Surgery, The Permanente Medical Group, Santa Clara, CA, USA
| | - E W Paxton
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA, USA
| | - R Mostaedi
- Department of Surgery, The Permanente Medical Group, Richmond, CA, USA
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Ortenzi M, Botteri E, Balla A, Podda M, Montori G, Sartori A. Nationwide analysis of open groin hernia repairs in Italy from 2015 to 2020. Hernia 2023; 27:1429-1437. [PMID: 37847334 DOI: 10.1007/s10029-023-02902-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: 08/31/2022] [Accepted: 09/22/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Inguinal hernia repair is one of the most commonly performed operations in general surgery. A total of 130.000 inguinal hernia repairs are performed yearly in Italy, and approximately 20 million inguinal hernias are treated worldwide annually. This report represents the trend analysis in inguinal hernia repair in Italy from a nationwide dataset for the 6-year period from 2015 to 2020. MATERIALS AND METHODS Based on regional hospital discharge records, all the inguinal hernia repairs performed in public and private hospitals in Italy between 2015 and 2020 were reviewed based on diagnosis and procedure codes. For the aim of this study, data from the AgeNas (The National Agency for Regional Health Services) data source were analyzed. RESULTS Elective inguinal hernia repairs outnumbered urgent operations over the 6-year study period, ranging from 122,737 operations in 2015 to 65,780 in 2020 as absolute numbers, and from 87.96 to 83.3% of total procedures in 2019 and 2020 respectively, with an annual change ranging from - 66.58%, between 2020 and 2019, to - 2.49%, between 2019 and 2018 (mean = - 18.74%; CI =- 46.7%-9.22%; p < 0.0001). CONCLUSIONS This large-scale review of groin hernia data from a nationwide Italian dataset provides a unique opportunity to obtain a snapshot of open groin hernia repair activity. More specifically, there is a trend to perform more elective than urgent procedures and there is a steady decrease in the amount of open hernia repairs in favor to laparoscopy.
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Affiliation(s)
- M Ortenzi
- Department of General Surgery, Università Politecnica delle Marche, Piazza Roma 22, 60121, Ancona, Italy.
| | - E Botteri
- ASST Spedali Civili Di Brescia PO Montichiari, Via Boccalera 325018, Montichiari, Brescia, Italy
| | - A Balla
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - M Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - G Montori
- Department of General Surgery, Ospedale Di Vittorio Veneto-ULSS2 Marca Trevigiana, Via Forlanini, 71, 31029, Vittorio Veneto, Treviso, Italy
| | - A Sartori
- Department of General Surgery, Ospedale Di Montebelluna, Via Palmiro Togliatti, 16, 31044, Montebelluna, Treviso, Italy
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Guillaumes S, Hidalgo NJ, Bachero I, Juvany M. Outpatient inguinal hernia repair in Spain: a population-based study of 1,163,039 patients-clinical and socioeconomic factors associated with the choice of day surgery. Updates Surg 2023; 75:65-75. [PMID: 36287386 PMCID: PMC9834115 DOI: 10.1007/s13304-022-01407-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/18/2022] [Indexed: 01/16/2023]
Abstract
Reducing inpatient admissions and health care costs is a central aspiration of worldwide health systems. This study aimed to evaluate trends in outpatient surgery in inguinal hernia repair (IHR) and factors related to the outpatient setting in Spain. A retrospective cohort study (Record-Strobe compliant) of 1,163,039 patients who underwent IHR from January 2004 to December 2019 was conducted. Data were extracted from the public clinical administrative database CMBD ("Conjunto Mínimo Básico de Datos"). The primary outcome was the outpatient surgery rate. Univariate and multivariable analyses were performed to identify clinical and socioeconomic factors related to the outpatient setting. The overall proportion of outpatient repairs was 30.7% in 2004 and 54.2% in 2019 (p < 0.001). Treatment in a public hospital was the most remarkable factor associated with the likelihood of receiving an outpatient procedure (OR 3.408; p < 0.001). There were also significant differences favouring outpatient procedures for patients with public insurance (OR 2.351; p < 0.001), unilateral hernia (OR 2.903; p < 0.001), primary hernia (OR 1.937; p < 0.0005), age < 65 years (OR 1.747; p < 0.001) and open surgery (OR 1.610; p < 0.001). Only 9% of patients who pay for their intervention privately or 15% of those covered by private insurance were treated as outpatients. Spain has significantly increased the rate of outpatient IHR over the last 16 years. However, the figures obtained still leave a significant margin for improvement. Important questions about the acceptance of outpatient settings remain to be answered. Outpatient inguinal hernia repair in Spain. A population-based study of 1,163,039 patients: clinical and socioeconomic factors associated with the choice of day surgery.
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Affiliation(s)
- Salvador Guillaumes
- grid.410458.c0000 0000 9635 9413Department of Gastrointestinal Surgery, Hospital Clinic de Barcelona (Seu Plató), C/Plató 21, 08006 Barcelona, Spain
| | - Nils Jimmy Hidalgo
- grid.410458.c0000 0000 9635 9413Department of Gastrointestinal Surgery, Hospital Clinic de Barcelona (Seu Plató), C/Plató 21, 08006 Barcelona, Spain
| | - Irene Bachero
- grid.410458.c0000 0000 9635 9413Department of Gastrointestinal Surgery, Hospital Clinic de Barcelona (Seu Plató), C/Plató 21, 08006 Barcelona, Spain
| | - Montserrat Juvany
- Department of Surgery, Hospital Universitari de Granollers, Granollers, Spain
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Guillaumes S, Juvany M. Inguinal hernia repairs performed for recurrence in Spain: population-based study of 16 years and 1,302,788 patients. Hernia 2022; 26:1023-1032. [PMID: 35624186 DOI: 10.1007/s10029-022-02630-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to assess data on inguinal hernia repairs (IHR) performed for recurrence over a 16 year period (2004-2019) in Spain. METHODS A retrospective cohort study of 1,302,788 patients who underwent IHR from January 2004 to December 2019 was conducted. Data were extracted from the Spanish Minimum Basic Data Set (MBDS) of the Health Ministry database. The primary objective was to analyse the proportion of IHR performed by recurrence. As secondary objectives, we evaluated factors related to recurrent hernia (analysed by univariate analysis and multivariable logistic regression analysis) and trends in the recurrent case rate over the 16 year period. RESULTS We identified 95,025 patients (7.3% of all IHR) who underwent surgery for recurrent inguinal hernia. Patients undergoing recurrent IHR were more likely to be male (OR 1.687, 95% CI 1.645-1.730), elderly (age > 74 years), and more complicated when they arrived in the operating room (gangrene OR 3.951, 95% CI 3.734-4.180; occlusion OR 1.905, 95% CI 1.853-1.960), and thus had more surgical site occurrences and related mortality. The proportion of IHR performed for recurrence has been dropping over the years (8.7% in 2004 vs. 6.5% in 2019, p < 0.005). CONCLUSION The rate of recurrent IHR in Spain (2004-2019) is 7.3%. Recurrent IHR correlates to emergent and complicated surgery and thus to a worst outcome. The trend of this 16 year period is of decreasing operated recurrent inguinal hernia. This is good news even though the improvement is slight and certainly insufficient. Establishing and optimising the rate of hernia recurrence is important for patients and for the health-care system.
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Affiliation(s)
- S Guillaumes
- Department of Gastrointestinal Surgery, Hospital Clinic de Barcelona, Clinic-Plató. C/Plató 21, 08006, Barcelona, Spain.
| | - M Juvany
- Department of Surgery, Hospital Universitari de Granollers, Universitat Internacional de Catalunya, Granollers, Spain
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Takayama Y, Kaneoka Y, Maeda A, Takahashi T, Seita K. Long-Term Outcomes Using a Questionnaire After Inguinal Hernia Repair in Female. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Guillaumes S, Hoyuela C, Hidalgo NJ, Juvany M, Bachero I, Ardid J, Martrat A, Trias M. Inguinal hernia repair in Spain. A population-based study of 263,283 patients: factors associated with the choice of laparoscopic approach. Hernia 2021; 25:1345-1354. [PMID: 33837883 DOI: 10.1007/s10029-021-02402-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of this study is to evaluate the laparoscopic inguinal hernia repair (IHR) rate in Spain and identify the factors associated with the choice of this surgical approach. METHODS A retrospective cohort study of 263,283 patients who underwent IHR from January 2016 to December 2018 was conducted. Data were extracted from the Spanish Minimum Basic Data Set (MBDS) of the Health Ministry database. The primary outcome was laparoscopic (LAP) rate utilization. Univariate analysis and multivariable logistic regression analysis were performed to identify factors associated with LAP-IHR. RESULTS Only 5.7% (15,059) patients underwent LAP-IHR, whereas the remnant 94.3% (248,224 patients) underwent open repair. High variability in the LAP-IHR rate across the country was observed; ranged between provinces from 0 to 19.7%, for a unilateral hernia, and between 0 to 57.4% in the case of bilateral hernias. On multivariate logistic regression analysis, the patient place of residence was the most remarkable factor associated with the likelihood of receiving LAP-IHR (OR 4.96; p < 0.001). There were also significant differences favoring LAP-IHR for bilateral operation (OR 4.596; p < 0.001), insurance coverage (OR 4.439, p < 0.001) and self-pay patients (OR 2.317; p < 0.001), as well as a recurrent hernia (OR 1.780; p < 0.001), age younger than 65 years (OR 1.555; p < 0.001) and male sex (OR 1.162, p < 0.001). CONCLUSION LAP-IHR remains a not frequent choice among surgeons in Spain, even when dealing with recurrent and bilateral hernias. The results suggest that the choice of LAP-IHR could depend on the surgeon's preference rather than on the indication appropriateness.
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Affiliation(s)
- S Guillaumes
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain.
| | - C Hoyuela
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - N J Hidalgo
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - M Juvany
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - I Bachero
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - J Ardid
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - A Martrat
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - M Trias
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
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Everling EM, Bandeira DS, Gallotti FM, Bossardi P, Tonatto-Filho AJ, Grezzana-Filho TDJM. OPEN VS LAPAROSCOPIC HERNIA REPAIR IN THE BRAZILIAN PUBLIC HEALTH SYSTEM. AN 11-YEAR NATIONWIDE POPULATION-BASED STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2021; 57:484-490. [PMID: 33331481 DOI: 10.1590/s0004-2803.202000000-85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Abdominal wall hernia is one of the most common surgical pathologies. The advent of minimally invasive surgery raised questions about the best technique to be applied, considering the possibility of reducing postoperative pain, a lower rate of complications, and early return to usual activities. OBJECTIVE To evaluate the frequency of open and laparoscopic hernioplasties in Brazil from 2008 to 2018, analyzing the rates of urgent and elective surgeries, mortality, costs, and the impact of laparoscopic surgical training on the public health system. METHODS Nationwide data from 2008 to 2018 were obtained from the public health registry database (DATASUS) for a descriptive analysis of the selected data and parameters. RESULTS 2,671,347 hernioplasties were performed in the period, an average of 242,850 surgeries per year (99.4% open, 0.6% laparoscopic). The economically active population (aged 20-59) constituted the dominant group (54.5%). There was a significant reduction (P<0.01) in open surgeries, without a compensatory increase in laparoscopic procedures. 22.3% of surgeries were urgent, with a significant increase in mortality when compared to elective surgeries (P<0.01). The distribution of laparoscopic surgery varied widely, directly associated with the number of digestive surgeons. CONCLUSION This study presents nationwide data on hernia repair surgeries in Brazil for the first time. Minimally invasive techniques represent a minor portion of hernioplasties. Urgent surgeries represent a high percentage when compared to other countries, with increased mortality. The data reinforce the need for improvement in the offer of services, specialized training, and equalization in the distribution of procedures in all regions.
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Affiliation(s)
- Eduardo Morais Everling
- Hospital Nossa Senhora da Conceição (HNSC), Departamento de Cirurgia Geral, Porto Alegre, RS, Brasil
| | - Daniela Santos Bandeira
- Hospital Nossa Senhora da Conceição (HNSC), Departamento de Cirurgia Geral, Porto Alegre, RS, Brasil
| | - Felipe Melloto Gallotti
- Hospital Nossa Senhora da Conceição (HNSC), Departamento de Cirurgia Geral, Porto Alegre, RS, Brasil.,Hospital Nossa Senhora das Graças, Unidade de Cirurgia do Aparelho Digestivo, Curitiba, PR, Brasil
| | - Priscila Bossardi
- Hospital Santa Casa de Misericórdia de Curitiba, Unidade de Dermatologia, Curitiba, PR, Brasil
| | - Antoninho José Tonatto-Filho
- Hospital Nossa Senhora da Conceição (HNSC), Departamento de Cirurgia Geral, Porto Alegre, RS, Brasil.,Hospital de Clínicas de Curitiba, Unidade de Cirurgia Plástica, Curitiba, PR, Brasil
| | - Tomaz de Jesus Maria Grezzana-Filho
- Hospital Nossa Senhora da Conceição (HNSC), Departamento de Cirurgia Geral, Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre (HCPA), Unidade de Cirurgia do Fígado e Transplantes, Porto Alegre, RS, Brasil
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8
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Influencing Factors on the Outcome in Female Groin Hernia Repair: A Registry-based Multivariable Analysis of 15,601 Patients. Ann Surg 2020; 270:1-9. [PMID: 30921052 DOI: 10.1097/sla.0000000000003271] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Based on an analysis of data from the Herniamed Registry, this study aims to identify all factors influencing the outcome in female groin hernia repair. BACKGROUND In a systematic review and meta-analysis of observational studies, female sex was found to be a significant risk factor for recurrence. In the guidelines, the totally extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) laparo-endoscopic techniques are recommended for female groin hernia repair. However, even when complying with the guidelines, a less favorable outcome must be expected than in men. To date, there is no study in the literature for analysis of all factors influencing the outcome in female groin hernia repair. METHODS In all, 15,601 female patients from the Herniamed Registry who had undergone primary unilateral groin hernia repair with the Lichtenstein, Shouldice, TEP or TAPP technique, and for whom 1-year follow-up was available, were selected between September 1, 2009 and July 1, 2017. Using multivariable analyses, influencing factors on the various outcome parameters were identified. RESULTS In the multivariable analysis, a significantly higher risk of postoperative complications, complication-related reoperations, recurrences, and pain on exertion was found only for the Lichtenstein technique. No negative influence on the outcome was identified for the TEP, TAPP, or Shouldice techniques. Relevant risk factors for occurrence of perioperative complications, recurrences, and chronic pain were preoperative pain, existing risk factors, larger defects, a higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) classification and postoperative complications. Higher age had a negative association with postoperative complications and positive association with pain rates. CONCLUSIONS Female groin hernia repair should be performed with the TEP or TAPP laparo-endoscopic technique, or, alternatively, with the Shouldice technique, if there is no evidence of a femoral hernia. By contrast, the Lichtenstein technique has disadvantages in terms of postoperative complications, recurrences, and pain on exertion. Important risk factors for an unfavorable outcome are preoperative pain, existing risk factors, higher ASA classification, higher BMI, and postoperative complications. A higher age and larger defects have an unfavorable impact on postoperative complications and a more favorable impact on chronic pain.
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Ochoa-Hernandez A, Timmerman C, Ortiz C, Huertas VL, Huerta S. Emergent groin hernia repair at a County Hospital in Guatemala: patient-related issues vs. health care system limitations. Hernia 2019; 24:625-632. [PMID: 31429024 DOI: 10.1007/s10029-019-02028-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/04/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The rate of emergent groin hernia repair in developing countries is poorly understood. MATERIALS AND METHODS A retrospective analysis of groin hernia repairs performed at a county hospital in Guatemala [Hospital Nacional de San Benito (HSNB)] was undertaken and compared to a literature review in developed countries. Patients with incarcerated hernias were interviewed to determine factors related to late presentation. RESULTS Twenty-five percent of patients with groin hernias in this analysis presented at HNSB emergently (vs. 2.5-7.7% in developed countries). Most patients were male in their fifth decade of life. Ten percent of hernias were femoral. There was no delay in scheduling patients for surgery presenting for elective repair. Most patients lived within 20 miles of the hospital, but only 50% of patients returned for their follow-up appointment. Most patients with an incarcerated inguinal hernia (56%) did not seek medical attention because of family obligations, but when they did, this decision was influence by their children (66%). None of the patients presenting with an incarcerated hernia had education past secondary school. In fact, most (56%) did not have any form formal education. Nearly 90% of patients who had an incarcerated hernia repaired thought that the hospital provided good-to-excellent care. CONCLUSION A high number of patients present emergently for groin hernia repair at a county hospital in Guatemala compared to developed countries. Our data suggest that emergent hernias are likely the result of patient-related issues rather than health care system limitations.
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Affiliation(s)
| | - C Timmerman
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Ortiz
- Hospital Nacional de San Benito, Petén, San Benito, Guatemala
| | - V L Huertas
- Hospital Nacional de San Benito, Petén, San Benito, Guatemala
| | - S Huerta
- University of Texas Southwestern Medical Center, Dallas, TX, USA. .,VA North Texas Health Care System, 4500 S. Lancaster Road, Dallas, TX, 75225, USA.
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10
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Köckerling F, Koch A, Lorenz R. Groin Hernias in Women-A Review of the Literature. Front Surg 2019; 6:4. [PMID: 30805345 PMCID: PMC6378890 DOI: 10.3389/fsurg.2019.00004] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/23/2019] [Indexed: 12/22/2022] Open
Abstract
Background: To date, there are few studies and no systematic reviews focusing specifically on groin hernia in women. Most of the existing knowledge comes from registry data. Objective: This present review now reports on such findings as are available on groin hernia in women. Materials and Methods: A systematic search of the available literature was performed in September 2018 using Medline, PubMed, Google Scholar, and the Cochrane Library. For the present analysis 80 publications were identified. Results: The lifetime risk of developing a groin hernia in women is 3-5.8%. The proportion of women in the overall collective of operated groin hernias is 8.0-11.5%. In women, the proportion of femoral hernias is 16.7-37%. Risk factors for development of a groin hernia in women of high age and with a positive family history. A groin hernia during pregnancy should not be operated on. The rate of emergency procedures in women, at 14.5-17.0%, is 3 to 4-fold higher than in men and at 40.6% is even higher for femoral hernia. Therefore, watchful waiting is not indicated in women. During surgical repair of groin hernia in females the presence of a femoral hernia should always be excluded and if detected should be repaired using a laparo-endoscopic or open preperitoneal mesh technique. A higher rate of chronic postoperative inguinal pain must be expected in females. Conclusion: Special characteristics must be taken into account for repair of groin hernia in women.
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Affiliation(s)
- Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
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11
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Wirth U, Saller ML, von Ahnen T, Köckerling F, Schardey HM, Schopf S. [Inguinal hernia repair in TAPP technique in a day-case surgery setting - at what price?]. Chirurg 2018; 88:792-798. [PMID: 28451730 DOI: 10.1007/s00104-017-0429-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND TAPP surgery can be considered as a gold standard in inguinal hernia repair. Patients benefit of a faster reconvalescence and less pain compared to other techniques. TAPP surgery in Germany is performed in an in-patient setting routinely. However, according to European guidelines, inguinal hernia surgery should be considered as day-case surgery whenever possible. OBJECTIVES The safety of day-case surgery was examined in relation to postoperative pain, complications, comorbidities, recurrent inguinal hernia and bilateral procedures. MATERIAL AND METHODS In a retrospective, monocentric study we analyzed 522 elective inguinal hernia repairs using TAPP technique in a specialized hernia center. Supplemental data from Herniamed registry is analyzed. RESULTS Parts of the procedures should be performed in an in-patient setting, whereas a much larger number of cases should be carried out as day-case surgeries. Logistic regression analyses show that "age", "bilateral procedures" and "comorbidities" affect the complication rate. "Age" and "recurrent inguinal hernia" are risk factors for an increased need for analgetic medication. Furthermore, we present an actual distribution of day-case vs. in-patient surgeries in inguinal hernia repair based on data from the Herniamed registry. CONCLUSION A much larger part of procedures could safely be carried out as day-case surgeries. Based on a false incentive there is an incorrect steering in the German health system. These procedures cannot be carried out covering the costs as day-surgery cases. If there is no reevaluation of the proceeds of these procedures in a day-case surgery setting, the reasonable quality in treatment is compromised especially in inguinal hernia surgery.
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Affiliation(s)
- U Wirth
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland. .,Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.
| | - M-L Saller
- Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.,Klinik für Rehabilitation und Innere Medizin, International Medical Center, Schön Klinik Vogtareuth, Vogtareuth, Deutschland
| | - T von Ahnen
- Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.,Abteilung für Allgemein-, Viszeral- und Gefäßchirurgie, Krankenhaus Agatharied, Hausham, Deutschland
| | - F Köckerling
- Klinik für Chirurgie-, Viszeral- und Gefäßchirurgie, Vivantes-Klinikum Spandau, Berlin, Deutschland
| | - H M Schardey
- Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.,Abteilung für Allgemein-, Viszeral- und Gefäßchirurgie, Krankenhaus Agatharied, Hausham, Deutschland
| | - S Schopf
- Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.,Abteilung für Allgemein-, Viszeral- und Gefäßchirurgie, Krankenhaus Agatharied, Hausham, Deutschland
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Abstract
BACKGROUND Surgical care is essential to health systems but remains a challenge for low- and middle-income countries (LMICs). Current metrics to assess access and delivery of surgical care focus on the structural components of surgery and are not readily applicable to all settings. This study assesses a new metric for surgical care access and delivery, the ratio of emergent surgery to elective surgery (Ee ratio), which represents the number of emergency surgeries performed for every 100 elective surgeries. METHODS A systematic search of PubMed and Medline was conducted for studies describing surgical volume and acuity published between 2006 and 2016. The relationship between Ee ratio and three national indicators (gross domestic product, per capital healthcare spending, and physician density) was analyzed using weighted Pearson correlation coefficients (r w) and linear regression models. RESULTS A total of 29 studies with 33 datasets were included for analyses. The median Ee ratio was 14.6 (IQR 5.5-62.6), with a range from 1.6 to 557.4. For countries in sub-Saharan Africa the median value was 62.6 (IQR 17.8-111.0), compared to 9.4 (IQR 3.4-13.4) for the United States and 5.5 (IQR 4.4-10.1) for European countries. In multivariable linear regression, the per capita healthcare spending was inversely associated with the Ee ratio, with a 63-point decrease in the Ee ratio for each 1 point increase in the log of the per capita healthcare spending (regression coefficient β = -63.2; 95% CI -119.6 to -6.9; P = 0.036). CONCLUSIONS The Ee ratio appears to be a simple and valid indicator of access to available surgical care. Global health efforts may focus on investment in low-resource settings to improve access to available surgical care.
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Postoperative Rehabilitation May Reduce the Risk of Readmission After Groin Hernia Repair. Sci Rep 2018; 8:6759. [PMID: 29712995 PMCID: PMC5928219 DOI: 10.1038/s41598-018-25276-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 04/17/2018] [Indexed: 01/23/2023] Open
Abstract
Thirty-day readmission after surgery has been proposed as a quality-of-care indicator. We explored the effect of postoperative rehabilitation on readmission risk after groin hernia repair. We used the French National Discharge Database to identify all index hospitalizations for groin hernia repair in 2011. Readmissions within 30 days of discharge were clinically classified in terms of their relationship to the index stay. We used logistic regression to adjust the risk of readmission for patient, procedure and hospital factors. Among 122,952 index hospitalizations for inguinal hernia repair, 3,357 (2.7%) related 30-day readmissions were recorded. Reiterated analyses indicated that readmission risk was consistently associated with patient complexity: age (per year after 60 years, OR 1.03, 95% CI 1.02-1.03, P < 0.001), hospitalization within the previous year (OR 1.56, 95% CI 1.44-1.69, P < 0.001), and increasing severity and combination of co-morbidities. Postoperative rehabilitation was identified as a protective factor (OR 0.56, 95% CI 0.46-0.69, P < 0.001). Older patients and those with greater comorbidity are at elevated risk of readmission after inguinal hernia repair. Postoperative rehabilitation may reduce this risk. Further studies are warranted to confirm the protective effect of postoperative rehabilitation.
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Lee CH, Chiu YT, Cheng CF, Wu JC, Yin WY, Chen JH. Risk factors for contralateral inguinal hernia repair after unilateral inguinal hernia repair in male adult patients: analysis from a nationwide population based cohort study. BMC Surg 2017; 17:106. [PMID: 29157231 PMCID: PMC5696739 DOI: 10.1186/s12893-017-0302-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/09/2017] [Indexed: 11/10/2022] Open
Abstract
Background To identify the rate of and risk factors for contralateral inguinal hernia (CIH) after unilateral inguinal hernia repair in adult male patients. Methods This retrospective cohort study identified from the Taiwan National Health Insurance Research Database (NHIRD). Information on all adult patients who underwent primary unilateral inguinal hernia repair without any other operation was collected using ICD-9 diagnostic and procedure codes. The exclusion criteria were laparoscopic hernia repair, non-primary repair, complicated hernia, other combined procedures, female and undetermined gender. Results A total of 170,492 adult male patients were included, with a median follow-up of 87 months. The overall CIH rate was 10.5%, with a median time of 48 months to a subsequent hernia operation. The 1-year, 2-year, 3-year and 5-year-recurrent rate was 2.6, 3, 4.3, and 6.7% respectively. Further, 3.7% patients who underwent CIH repair had a complicated inguinal hernia. Multivariate analysis demonstrated that age > 45 y, direct hernia, cirrhosis (HR = 1.564), severe liver disease (HR = 1.663), prostate disease (HR = 1.178), congestive heart failure (HR = 1.138), and history of malignancy (HR = 1.116) had a significantly higher risk of CIH repair. Conclusions Among adult male patients undergoing long-term follow-up, we identified several significant risk factors for CIH repair. If these risk factors are presented, the surgeon should inform the following risk of CIH repair to patients so that it can be repaired as soon as possible.
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Affiliation(s)
- Cheng-Hung Lee
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan
| | - Yu-Ting Chiu
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chi-Fu Cheng
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jin-Chia Wu
- Department of Colorectal Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wen-Yao Yin
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jian-Han Chen
- Department of General Surgery, E-Da Hospital, No.1, Yida Road, Jiao-su Village, Yan-chao District, Kaohsiung City, 824, Taiwan, Republic of China. .,School of Medicine, I-Shou University, Kaohsiung, Taiwan.
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15
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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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Lee CH, Chen Y, Cheng CF, Yao CL, Wu JC, Yin WY, Chen JH. Incidence of and Risk Factors for Pediatric Metachronous Contralateral Inguinal Hernia: Analysis of a 17-Year Nationwide Database in Taiwan. PLoS One 2016; 11:e0163278. [PMID: 27684710 PMCID: PMC5042430 DOI: 10.1371/journal.pone.0163278] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/05/2016] [Indexed: 11/22/2022] Open
Abstract
Background Previous prospective, retrospective, and meta-analysis studies revealed that the overall incidence of metachronous contralateral inguinal hernia (MCIH) ranges from 5.76% to 7.3%, but long-term follow-up postoperative data are scant. We identified the incidence and risk factors of MCIH in pediatric patients during the follow-up using the Taiwan National Health Insurance Research Database (NHIRD). Methods Between 1996/01/01 and 2008/12/31, all pediatric patients with primary unilateral inguinal hernia repair who were born after 1996/01/01 were collected via ICD-9 diagnostic and procedure codes recorded in NHIRD. Patients with another operation during the same admission, complicated hernia, or laparoscopic procedure were excluded. Several reported risk factors, including age, sex, preterm birth, low body weight, and previous ventriculoperitoneal shunt placement, were used for analysis. The primary endpoint was the repairmen of MCIH following the initial surgery. All patients were followed until 2013/12/31 or withdrawal from national health insurance. Results A total of 31,100 pediatric patients underwent unilateral inguinal hernia repair, and 111.76 months of median follow-up data were collected. The overall rate of MCIH was 12.3%. Among the 31,100 patients who had the hernia repair, 63.6% had MCIH within 2 years and 91.5% had MCIH within 5 years. After initial surgery, the incidence of MCIH gradually and significantly decreased with age up to approximately 6 years. Multivariable analysis showed that age <4 y and girls were risk factors for subsequent MCIH. Conclusions After 17 years of follow-up, the overall MCIH rate was 12.3%, and 91.7% of patients needed repair for MCIH within the first 5 years after initial surgery. Age <4 years and girls were risk factors for MCIH. The contralateral exploration for inguinal hernia should be considered among these patients.
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Affiliation(s)
- Cheng-Hung Lee
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yun Chen
- Department of Surgery, Far Eastern Memorial Hospital, Pan-Ciao, New Taipei, Taiwan
| | - Chi-Fu Cheng
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chao-Lin Yao
- Department of Chemical Engineering and Materials Science, Yuan Ze University, Chung-Li, Taoyuan City, 32003, Taiwan
- Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Chung-Li, Taoyuan City, 32003, Taiwan
| | - Jin-Chia Wu
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wen-Yao Yin
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jian-Han Chen
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- * E-mail:
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Montori G, Coccolini F, Manfredi R, Ceresoli M, Campanati L, Magnone S, Pisano M, Poiasina E, Nita G, Catena F, Ansaloni L. One year experience of swine dermal non-crosslinked collagen prostheses for abdominal wall repairs in elective and emergency surgery. World J Emerg Surg 2015; 10:28. [PMID: 26136817 PMCID: PMC4487506 DOI: 10.1186/s13017-015-0023-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/22/2015] [Indexed: 02/08/2023] Open
Abstract
Introduction The approach to the abdominal wall surgical repair is dramatically changed in the last years. This study evaluates our institutional outcomes about the usage of biological meshes for abdominal wall repair in different setting: in elective surgery, in emergency surgery and in abdominal wall repair following open abdomen (OA) procedure. Methods A database was prospectively conducted (January–December 2014) and data were reviewed for patients who underwent to an abdominal wall reconstruction with swine dermal non-cross linked collagens prostheses either in elective or emergency setting, and following OA/laparostomy procedure. Demographic data, co-morbidities, indications for surgery, intra-operative details, post-operative complications and outcome (peri-operative, 3, 6, 9-months) were analyzed. Results A total of 30 cases were reported: 9 in elective surgery (Group 1), 4 in emergency surgery (Group 2) and 17 with abdominal wall closure following OA management (Group 3). Two meshes were removed: 1 in the Group 1 and 1 in the Group 3. During follow-up only one patient in the Group 3 had a recurrence of the incisional hernia. Mortality rate was 11.1 % at 3 months in Group 1, 0 % in the Group 2, and 29.4 % in peri-operative period in the Group 3. Conclusions The use of non-cross linked biological meshes can be safe and versatile in different situations from elective to emergency surgery, and also for the reconstruction of the abdominal wall after OA procedure, with an acceptable recurrence and mortality rate.
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Affiliation(s)
- Giulia Montori
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Federico Coccolini
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Roberto Manfredi
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Marco Ceresoli
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Luca Campanati
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Stefano Magnone
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Michele Pisano
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Elia Poiasina
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Gabriela Nita
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Fausto Catena
- General surgery department, Ospedale Maggiore, Parma, Italy
| | - Luca Ansaloni
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
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Keller JJ, Muo CH, Lan YC, Sung FC, Lo FE, Chiang KY, Lyu SY, Tsai ST. A nation-wide population-based study of inguinal hernia repair incidence and age-stratified recurrence in an Asian population. Hernia 2015; 19:735-40. [PMID: 25739714 DOI: 10.1007/s10029-015-1359-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/20/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE It has been estimated in the UK that 27 % of men and 3 % of women will undergo an inguinal hernia repair (IHR) during their lifetimes. However, no epidemiologic study investigating IHR has been performed to date in an Asian population. The present study explored the incidence and recurrence of IHR in an Asian population using a nation-wide population-based dataset in Taiwan. METHODS Based on the National Health Insurance Database, we identified 5806 patients who underwent an IHR between 2000 and 2010 and followed them until they had a recurrence, died during hospitalization, left the program, or the study ended. We calculated the age-stratified recurrence rates and used Cox proportional hazards to explore the influence of demographic and clinical factors on recurrence. We also plotted IHR occurrence over the study period. RESULTS Among the 5806 sampled subjects who had an IHR, 565 (9.73 %) had an IHR recurrence yielding an overall incidence of 18.23 per 1000 person-years. The hazard ratios for recurrence increased with age, and were greater among men and blue collar workers. The incidence of IHR decreased from 168.21 to 92.10 per 100,000 person-years over the study period. Surgical complication rates ranged between 0.16 and 2.57 %. CONCLUSIONS On account of the increased risk of recurrence with age, young hernia patients may not want to delay surgery. This study detected a decreasing trend in initial IHR rates, confirming similar trends reported in Western countries. However, the incidence of initial IHR is lower in Taiwan than it is in the West.
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Affiliation(s)
- J J Keller
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, 250 Wu-Hsing St., Taipei, 110, Taiwan
| | - C-H Muo
- Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University and Hospital, Taichung, Taiwan
| | - Y-C Lan
- Department of Health Risk Management, China Medical University, Taichung, Taiwan
| | - F-C Sung
- Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan
| | - F-E Lo
- Department of Leisure and Recreation Management, Asia University, Taichung, Taiwan
| | - K-Y Chiang
- Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - S-Y Lyu
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, 250 Wu-Hsing St., Taipei, 110, Taiwan.
- Indigenous Health and Preventive Medicine Research Center, Taipei Medical University, Taipei, Taiwan.
| | - S-T Tsai
- Division of General Surgery, Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan.
- Indigenous Health and Preventive Medicine Research Center, Taipei Medical University, Taipei, Taiwan.
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19
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Samuel JC, Tyson AF, Mabedi C, Mulima G, Cairns BA, Varela C, Charles AG. Development of a ratio of emergent to total hernia repairs as a surgical capacity metric. Int J Surg 2014; 12:906-11. [PMID: 25084098 DOI: 10.1016/j.ijsu.2014.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 06/05/2014] [Accepted: 07/21/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Non-communicable diseases including surgical conditions are gaining attention in developing countries. Despite this there are few metrics for surgical capacity. We hypothesized that (a) the ratio of emergent to total hernia repairs (E/TH) would correlate with per capita health care expenditures for any given country, and (b) the E/TH is easy to obtain in resource-poor settings. METHODS We performed a systematic review to identify the E/TH for as many countries as possible (Prospero registry CRD42013004645). We screened 1285 English language publications since 1990; 23 met inclusion criteria. Primary data was also collected from Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. A total of 13 countries were represented. Regression analysis was used to determine the correlation between per capita health care spending and the E/TH. RESULTS There is a strong correlation between the log values of the ratio emergent to total groin hernias and the per capita health care spending that is robust across country income levels (R(2) = 0.823). Primary data from KCH was easily obtained and demonstrated a similar correlation. CONCLUSIONS The ratio of emergent to total groin hernias is a potential measure of surgical capacity using data that is easily attainable. Further studies should validate this metric against other accepted health care capacity indicators. Systematic review registered with Prospero (CRD42013004645).
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Affiliation(s)
- Jonathan C Samuel
- NC Jaycee Burn Center, Department of Surgery, University of North Carolina, 101 Manning Drive CB 7600, Chapel Hill, NC 27759, USA.
| | - Anna F Tyson
- Department of Surgery, University of North Carolina, 4001 Burnett Womack Bldg CB 7050, Chapel Hill, NC 27599, USA
| | - Charles Mabedi
- Department of Surgery, Kamuzu Central Hospital, PO Box 149, Lilongwe, Malawi
| | - Gift Mulima
- Department of Surgery, Kamuzu Central Hospital, PO Box 149, Lilongwe, Malawi
| | - Bruce A Cairns
- NC Jaycee Burn Center, Department of Surgery, University of North Carolina, 101 Manning Drive CB 7600, Chapel Hill, NC 27759, USA
| | - Carlos Varela
- Department of Surgery, Kamuzu Central Hospital, PO Box 149, Lilongwe, Malawi
| | - Anthony G Charles
- Department of Surgery, University of North Carolina, 4001 Burnett Womack Bldg CB 7050, Chapel Hill, NC 27599, USA
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