Reid Chris M, Brandel Michael G, Gosman Amanda A
From the Division of Plastic Surgery, Department of Surgery, UC San Diego Medical Center, San Diego, CA.
Ann Plast Surg. 2017 May;78(5 Suppl 4):S212-S216. doi: 10.1097/SAP.0000000000000971.
Ventral hernia repair is a common procedure and is undertaken by surgeons with varying training backgrounds. Outcomes after hernia repair depend on numerous factors, some being patient or surgeon specific. It remains unclear what the ideal roles are for general and plastic surgeons in open ventral hernia repair. We hypothesized that open ventral hernia repair by plastic surgeons is safe and comparable with general surgeons.
We performed a retrospective observational study using data from the National Surgical Quality Improvement Program database from 2007 to 2013. Patients with a primary diagnosis of ventral hernia undergoing open repair were identified. Multivariate regression modeling was performed, adjusting for surgeon specialty, patient characteristics, common concurrent procedures, and the total number of concurrent procedures. Outcomes studied were major and minor 30-day complications, operation time, readmission, unplanned reoperation, and length of hospital stay.
We identified 53,746 patients who underwent open repair, 53,282 (99.1%) by general surgeons (GS) and 464 (0.9%) by plastic surgeons (PS). There were significantly different rates of concurrent panniculectomy (12.1% PS vs 2.4% GS) and component separation (24.8% PS vs 5.3% GS), representing increased PS case complexity. 52.3% of GS and 92.9% of PS performed panniculectomy without an alternate specialty surgeon. 81.3% of GS and 97.4% of PS performed component separation without an alternate specialty surgeon. The PS patients had a significantly longer uncorrected length of stay and operation time than GS patients (all P < 0.001). Similarly, PS was positively associated with uncorrected major and minor complications (P < 0.001). However, these relationships did not persist on multivariate analysis after adjusting for demographic characteristics, medical comorbidities, concurrent procedures, and total procedure load. Furthermore, PS was associated with lower odds of major complications (operating room, 0.49; P = 0.05) compared with GS.
Outcomes of hernia repair by plastic surgeons are comparable with general surgeons, despite plastic surgeons being involved in many complex cases. Interestingly, we identified that general surgeons are performing adjunctive procedures to ventral hernia previously handled by plastic surgeons. Although further study is warranted, we conclude that for open ventral hernia repair, plastic surgeons provide a comparable alternative to general surgeons.
腹疝修补术是一种常见手术，由不同培训背景的外科医生实施。疝修补术后的结果取决于众多因素，有些因素是患者或外科医生特有的。普通外科医生和整形外科医生在开放性腹疝修补术中的理想角色仍不明确。我们假设整形外科医生进行的开放性腹疝修补术是安全的，且与普通外科医生相当。
我们使用2007年至2013年国家外科质量改进计划数据库中的数据进行了一项回顾性观察研究。确定了原发性诊断为腹疝并接受开放性修补术的患者。进行了多变量回归建模，对外科医生专业、患者特征、常见同期手术以及同期手术总数进行了调整。研究的结果包括30天的主要和次要并发症、手术时间、再入院、计划外再次手术以及住院时间。
我们确定了53746例接受开放性修补术的患者，其中普通外科医生（GS）进行了53282例（99.1%），整形外科医生（PS）进行了464例（0.9%）。同期行腹壁成形术的比例（PS为12.1%，GS为2.4%）和组织分离术的比例（PS为24.8%，GS为5.3%）存在显著差异，这表明PS组病例更为复杂。52.3%的GS医生和92.9%的PS医生在没有其他专科医生协助的情况下进行了腹壁成形术。81.3%的GS医生和97.4%的PS医生在没有其他专科医生协助的情况下进行了组织分离术。PS组患者未经校正的住院时间和手术时间明显长于GS组患者（所有P<0.001）。同样，PS与未经校正的主要和次要并发症呈正相关（P<0.001）。然而，在对人口统计学特征、内科合并症、同期手术和总手术负荷进行调整后的多变量分析中，这些关系并不持续存在。此外，与GS相比，PS组发生主要并发症的几率较低（手术室，0.49；P=0.05）。
尽管整形外科医生参与了许多复杂病例，但他们进行疝修补术的结果与普通外科医生相当。有趣的是，我们发现普通外科医生正在实施以前由整形外科医生处理的腹疝辅助手术。尽管有必要进一步研究，但我们得出结论，对于开放性腹疝修补术，整形外科医生是普通外科医生的一个相当的替代选择。
