Division of Minimally Invasive, Foregut, and Bariatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792-7375, USA.
Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Surg Endosc. 2021 Aug;35(8):4444-4451. doi: 10.1007/s00464-020-07947-0. Epub 2020 Sep 9.
The diagnosis of inguinal hernias is predominantly based on physical exam, although imaging may be used in select cases. The objective of this study was to determine the frequency of unnecessary imaging used in the diagnosis of inguinal hernias.
Patients who underwent elective inguinal hernia repair at a large academic health system in the U.S. from 2010 to 2017 were included. Within this cohort, we identified patients who received imaging 6 months prior to surgery. Through chart review of physical exam findings and imaging indications, we categorized patients into four imaging categories: unrelated, necessary, unnecessary, and borderline. Multivariable logistic regression analysis was used to identify factors associated with receipt of unnecessary imaging.
Of 2162 patients who underwent inguinal hernia surgery, 249 patients had related imaging studies 6 months prior to surgery. 47.0% of patients received unnecessary imaging. 66.9% and 33.1% of unnecessary studies were ultrasounds and CT scans, respectively. 24.5% of patients had necessary studies, while 28.5% had studies with borderline indications. On multivariable analysis, having a BMI between 25.0 and 29.9 kg/m was associated with receipt of unnecessary studies. Primary care providers and ED physicians were more likely to order unnecessary imaging.
Nearly 50% of all patients who receive any related imaging prior to surgery had potentially unnecessary diagnostic radiology studies. This not only exposes patients to avoidable risks, but also places a significant economic burden on patients and our already-strained health system.
腹股沟疝的诊断主要基于体格检查，尽管在某些情况下可能会使用影像学检查。本研究的目的是确定在诊断腹股沟疝时使用不必要的影像学检查的频率。
本研究纳入了 2010 年至 2017 年在美国一家大型学术医疗系统接受择期腹股沟疝修补术的患者。在该队列中，我们确定了在手术前 6 个月接受影像学检查的患者。通过对体格检查结果和影像学检查指征的病历回顾，我们将患者分为四类影像学检查：无关、必要、不必要和边缘。采用多变量逻辑回归分析确定与接受不必要影像学检查相关的因素。
在 2162 例接受腹股沟疝手术的患者中，有 249 例患者在手术前 6 个月有相关的影像学研究。47.0%的患者接受了不必要的影像学检查。66.9%和 33.1%的不必要研究分别为超声和 CT 扫描。24.5%的患者有必要的研究，而 28.5%的患者有边界指征的研究。多变量分析显示，BMI 在 25.0 至 29.9 kg/m 之间与接受不必要的研究相关。初级保健提供者和急诊科医生更有可能开具不必要的影像学检查。
近 50%的在手术前接受任何相关影像学检查的患者都有可能接受了不必要的诊断性放射学检查。这不仅使患者面临可避免的风险，而且还对患者和我们本已紧张的医疗系统造成了巨大的经济负担。
