Department of Surgery, University of Michigan, 2800 Plymouth Road, Building 16, 1st Floor, Ann Arbor, MI, 48109, USA.
Center for Health Outcomes and Policy, Ann Arbor, MI, 48109, USA.
Surg Endosc. 2019 Dec;33(12):4032-4037. doi: 10.1007/s00464-019-06695-0. Epub 2019 Feb 14.
Black patients and older adults are less likely to receive minimally invasive hernia repair. These differences by race and age may be influenced by surgeon-specific utilization rate of minimally invasive repair. In this study, we explored the association between race, age, and surgeon utilization of minimally invasive surgery (MIS) with the likelihood of receiving MIS inguinal hernia repair.
A retrospective cohort study was performed in patients undergoing elective primary inguinal hernia repair from 2012 to 2016, using data from the Michigan Surgical Quality Collaborative, a 72-hospital clinical registry. Surgeons were stratified by proportion of MIS performed. Using hierarchical logistic regression models, we investigated the association between receiving MIS repair and race, age, and surgeon MIS utilization rate.
Out of 4667 patients, 1253 (27%) received MIS repair. Out of 190 surgeons, 81 (43%) performed only open repair. Controlling for surgeon MIS utilization, race was not associated with MIS receipt (OR 0.93, p = 0.775), but older patients were less likely to receive MIS repair (OR 0.41, p < 0.001).
Race differences were explained by surgeon MIS utilization, implicating access to MIS-performing surgeon as a mediator. Conversely, age disparity was independent of MIS utilization, even after adjusting for comorbidities, indicating some degree of provider bias against performing MIS repair in older patients. Interventions to address disparities should include systematic efforts to improve access, as well as provider and patient education for older adults.
黑人和老年人接受微创疝修复的可能性较低。这种种族和年龄的差异可能受到外科医生微创修复具体使用率的影响。在这项研究中，我们探讨了种族、年龄和外科医生对微创手术（MIS）的使用与接受 MIS 腹股沟疝修复的可能性之间的关系。
这是一项回顾性队列研究，纳入了 2012 年至 2016 年期间接受择期原发性腹股沟疝修复的患者，数据来自密歇根手术质量协作组织（一个 72 家医院的临床登记处）。外科医生按 MIS 实施比例分层。我们使用分层逻辑回归模型，调查了接受 MIS 修复与种族、年龄和外科医生 MIS 使用率之间的关系。
在 4667 名患者中，有 1253 名（27%）接受了 MIS 修复。在 190 名外科医生中，有 81 名（43%）仅进行开放修复。控制外科医生 MIS 使用率后，种族与 MIS 接受率无关（OR 0.93，p=0.775），但老年患者接受 MIS 修复的可能性较低（OR 0.41，p<0.001）。
种族差异可由外科医生 MIS 使用率解释，提示 MIS 手术医生的获得情况是一个中介因素。相反，即使在调整了合并症后，年龄差异也与 MIS 使用率无关，这表明在老年患者中，提供者存在对 MIS 修复的一定程度的偏见。解决差异的干预措施应包括系统地努力改善获取途径，以及对老年患者进行提供者和患者教育。
