Department of Surgery, University of Michigan, 2800 Plymouth Road, Building 16, 1st Floor, Ann Arbor, MI, 48109, USA.
Center for Healthcare Outcomes and Policy, Ann Arbor, MI, 48109, USA.
Surg Endosc. 2019 Feb;33(2):486-493. doi: 10.1007/s00464-018-6322-x. Epub 2018 Jul 9.
MIS utilization for inguinal hernia repair is low compared to in other procedures. The impact of low adoption in surgeons is unclear, but may affect regional access to minimally invasive surgery (MIS). We explored the impact of surgeon MIS utilization in inguinal hernia repair across a statewide population.
We analyzed 6723 patients undergoing elective inguinal hernia repair from 2012 to 2016 in the Michigan Surgical Quality Collaborative. The primary outcome was surgeon MIS utilization. The geographic distribution of high MIS-utilizing surgeons was compared across Hospital Referral Regions using Pearson's Chi-squared test. Hierarchical logistic regression was used to identify patient and hospital factors associated with MIS utilization.
Surgeon MIS utilization varied, with 58% of 540 surgeons performing no MIS repair. For the remaining surgeons, MIS utilization was bimodally distributed. High-utilization surgeons were unevenly distributed across region, with corresponding differences in regional MIS rate ranging from 10 to 48% (p < 0.001). MIS was used in 41% of bilateral and 38% of recurrent hernia. MIS repair was more likely with higher hospital volume and less likely for patients aged 65+ (OR 0.68, p = 0.003), black patients (OR 0.75, p = 0.045), patients with COPD (OR 0.57, p < 0.001), and patients in ASA class > 3 (OR 0.79 p < 0.001).
MIS utilization varies between surgeons, likely driving differences in regional MIS rates and leading to guideline-discordant care for patients with bilateral or recurrent hernia. Interventions to reduce this practice gap could include training programs in MIS repair, or regionalization of care to improve MIS access.
与其他手术相比，微创外科（MIS）在腹股沟疝修补术中的应用率较低。低使用率对外科医生的影响尚不清楚，但可能会影响到区域内微创外科的应用。我们探讨了全州范围内外科医生在腹股沟疝修补术中使用 MIS 的情况及其影响。
我们分析了 2012 年至 2016 年期间在密歇根州外科质量协作组织接受择期腹股沟疝修补术的 6723 例患者。主要结果是外科医生 MIS 的使用率。使用 Pearson's Chi-squared 检验比较高 MIS 使用率外科医生在医院转诊区的地理分布。使用分层逻辑回归分析确定与 MIS 使用相关的患者和医院因素。
外科医生 MIS 的使用率差异很大，540 名外科医生中有 58%未进行 MIS 修复。对于其余的外科医生，MIS 的使用率呈双峰分布。高使用率的外科医生在区域分布不均，相应的区域 MIS 率差异从 10%到 48%（p<0.001）。MIS 用于 41%的双侧疝和 38%的复发性疝。医院容量较高时，MIS 修复的可能性更大，而年龄在 65 岁以上的患者（OR 0.68，p=0.003）、黑人患者（OR 0.75，p=0.045）、COPD 患者（OR 0.57，p<0.001）和 ASA 分级>3 级的患者（OR 0.79，p<0.001），MIS 修复的可能性较小。
外科医生之间 MIS 的使用率存在差异，这可能导致区域 MIS 率的差异，并导致双侧或复发性疝患者的治疗指南不一致。减少这种实践差距的干预措施可能包括 MIS 修复培训计划，或区域化护理以改善 MIS 的获得。
