Thiels Cornelius A, Holst Kimberly A, Ubl Daniel S, McKenzie Travis J, Zielinski Martin D, Farley David R, Habermann Elizabeth B, Bingener Juliane
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.
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
J Surg Res. 2017 Apr;210:59-68. doi: 10.1016/j.jss.2016.10.028. Epub 2016 Nov 5.
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.
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.
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).
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.
临床治疗指南表明，对于双侧或复发性择期腹股沟疝的男性和女性患者，腹腔镜疝修补术均应作为首选方法。然而，有轶事证据表明，女性接受腹腔镜修补术的可能性低于男性，因此，我们旨在确定在控制患者因素和合并症后这些差异是否仍然存在。
提取了美国外科医师学会国家外科质量改进项目中2005年至2014年间所有择期腹股沟疝修补术的数据。采用单因素分析比较男性和女性的腹腔镜手术率。进行多变量分析，控制患者人口统计学特征、术前合并症和手术年份。
在这10年期间，141,490例患者接受了择期腹股沟疝修补术，其中13,325例为女性（9.4%）。男性（81.3%）和女性（77.2%）的全身麻醉使用率都很高，75.1%的开放修补术在全身麻醉下进行。总体而言，20.2%的女性接受了腹腔镜修补术，而男性为28.0%（P < 0.01）。女性往往年龄较大，体重指数较低，美国麻醉医师协会分级略高（所有P < 0.05）。在多变量回归分析中，与男性相比，女性接受腹腔镜手术的几率降低（比值比：0.70；95%置信区间，0.67 - 0.73，P < 0.01）。
在择期手术中，女性接受腹股沟疝腹腔镜修补术的可能性低于男性。尽管我们无法确定这些性别差异的潜在原因，但这些数据表明女性腹股沟疝的治疗仍存在差异。
