Madenci Arin L, Wolf Lindsey L, Jiang Wei, Koehlmoos Tracey P, Learn Peter A, Haider Adil H, Smink Douglas S
Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA.
Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard Medical School, One Brigham Circle, 1620 Tremont St, Boston, MA.
Mil Med. 2018 Sep 1;183(9-10):e420-e426. doi: 10.1093/milmed/usy029.
The factors that contribute to variation in utilization of laparoscopic inguinal hernia repair are unknown. We sought to determine the current usage patterns of laparoscopic and open surgery in the elective repair of uncomplicated unilateral inguinal hernia in a large population with universal health care coverage comprised of Department of Defense (DoD) beneficiaries.
The DoD Military Health System Data Repository (MDR) tracks health care delivered to a universally insured population of active/reserve/retired members of the U.S. Armed Services and their dependents. The MDR was queried for elective unilateral inguinal hernia repair among adult patients between 2008 and 2014. The primary outcome was laparoscopic (vs. open) approach to hernia repair. We conducted univariable and multivariable analyses of patient- and systems-level factors associated with approach to inguinal hernia repair. This research was approved by our institutional review board prior to commencement of the study and need for informed consent was waived given the design of this study.
Among 37,742 elective uncomplicated unilateral inguinal hernia repairs, 35% (n = 13,114) were performed laparoscopically. In 2014, 40% of inguinal hernia repairs were performed laparoscopically, compared with 27% of repairs in 2008 (P < 0.01). In multivariable analysis, laparoscopic hernia repair was more likely for male patients (OR = 1.38, 95% CI = 1.23-1.54, P < 0.01), military (vs. civilian) institutions (OR = 1.34, 95% CI = 1.28-1.41, P < 0.01), active-duty officers (vs. active-duty enlisted; OR = 1.21, 95% CI = 1.12-1.30, P < 0.01), and more recent year of surgery (P < 0.01). Laparoscopic repair was significantly less likely among patients with greater than one comorbidity (vs. none; OR = 0.68, 95% CI = 0.61-0.76, P < 0.01).
In a large, universally insured population of military service members and their dependents, laparoscopic inguinal repair is increasingly used and was preferred over open repair for younger, healthier, active-duty patients and those treated within the military (vs. non-military) care system.
导致腹腔镜腹股沟疝修补术使用率存在差异的因素尚不清楚。我们试图确定在由国防部（DoD）受益人组成的享有全民医保的大量人群中，腹腔镜手术和开放手术在择期修补单纯性单侧腹股沟疝方面的当前使用模式。
国防部军事医疗系统数据仓库（MDR）追踪为美国武装部队现役/预备役/退休成员及其家属这一全民参保人群提供的医疗服务。对2008年至2014年期间成年患者的择期单侧腹股沟疝修补术进行了查询。主要结局是疝修补术的腹腔镜（与开放）入路。我们对与腹股沟疝修补术入路相关的患者和系统层面因素进行了单变量和多变量分析。本研究在开始前获得了我们机构审查委员会的批准，鉴于本研究的设计，无需获得知情同意。
在37742例择期单纯性单侧腹股沟疝修补术中，35%（n = 13114）采用了腹腔镜手术。2014年，40%的腹股沟疝修补术采用了腹腔镜手术，而2008年这一比例为27%（P < 0.01）。在多变量分析中，男性患者（OR = 1.38，95% CI = 1.23 - 1.54，P < 0.01）、军事（与民用）机构（OR = 1.34，95% CI = 1.28 - 1.41，P < 0.01）、现役军官（与现役士兵相比；OR = 1.21，95% CI = 1.12 - 1.30，P < 0.01）以及更近的手术年份（P < 0.01）进行腹腔镜疝修补术的可能性更大。合并症多于一种的患者进行腹腔镜修补术的可能性显著降低（与无合并症患者相比；OR = 0.68，95% CI = 0.61 - 0.76，P < 0.01）。
在一个由军人及其家属组成的大型全民参保人群中，腹腔镜腹股沟疝修补术的使用越来越多，对于年轻、健康的现役患者以及在军事（与非军事）医疗系统接受治疗的患者，腹腔镜修补术比开放修补术更受青睐。
