Department of Surgery, The Permanente Medical Group, Walnut Creek, CA, USA.
Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA, USA.
Hernia. 2023 Oct;27(5):1209-1223. doi: 10.1007/s10029-023-02796-x. Epub 2023 May 6.
The aim of this study was to describe a cohort of patients who underwent inguinal hernia repair within a United States-based integrated healthcare system (IHS) and evaluate the risk for postoperative events by surgeon and hospital volume within each surgical approach, open, laparoscopic, and robotic.
Patients aged ≥ 18 years who underwent their first inguinal hernia repair were identified for a cohort study (2010-2020). Average annual surgeon and hospital volume were broken into quartiles with the lowest volume quartile as the reference group. Multiple Cox regression evaluated risk for ipsilateral reoperation following repair by volume. All analyses were stratified by surgical approach (open, laparoscopic, and robotic).
110,808 patients underwent 131,629 inguinal hernia repairs during the study years; procedures were performed by 897 surgeons at 36 hospitals. Most repairs were open (65.4%), followed by laparoscopic (33.5%) and robotic (1.1%). Reoperation rates at 5 and 10 years of follow-up were 2.4% and 3.4%, respectively; rates were similar across surgical groups. In adjusted analysis, surgeons with higher laparoscopic volumes had a lower reoperation risk (27-46 average annual repairs: hazard ratio [HR] = 0.63, 95% confidence interval [CI] 0.53-0.74; ≥ 47 repairs: HR 0.53, 95% CI 0.44-0.64) compared to those in the lowest volume quartile (< 14 average annual repairs). No differences in reoperation rates were observed in reference to surgeon or hospital volume following open or robotic inguinal hernia repair.
High-volume surgeons may reduce reoperation risk following laparoscopic inguinal hernia repair. We hope to better identify additional risk factors for inguinal hernia repair complications and improve patient outcomes with future studies.
本研究旨在描述在美国综合医疗系统（IHS）中接受腹股沟疝修补术的患者队列，并评估每种手术方法（开放、腹腔镜和机器人）中，按外科医生和医院数量划分的术后事件风险。
对 2010 年至 2020 年期间进行首次腹股沟疝修补术的患者进行队列研究。将平均每年外科医生和医院数量分为四分位数，最低数量四分位数作为参考组。多变量 Cox 回归评估了按体积修复后同侧再次手术的风险。所有分析均按手术方式（开放、腹腔镜和机器人）进行分层。
在研究期间，有 110808 例患者接受了 131629 例腹股沟疝修补术，手术由 36 家医院的 897 名外科医生完成。大多数手术为开放式（65.4%），其次是腹腔镜（33.5%）和机器人（1.1%）。5 年和 10 年的随访再手术率分别为 2.4%和 3.4%，各手术组之间的比率相似。在调整后的分析中，腹腔镜手术量较高的外科医生再手术风险较低（27-46 例/年：风险比[HR]0.63，95%置信区间[CI]0.53-0.74；≥47 例/年：HR 0.53，95% CI 0.44-0.64）与最低四分位数（每年<14 例）相比。在开放或机器人腹股沟疝修补术后，未观察到外科医生或医院数量对再手术率的差异。
高容量外科医生可能会降低腹腔镜腹股沟疝修补术后的再手术风险。我们希望通过未来的研究，更好地确定腹股沟疝修补术并发症的其他危险因素，改善患者的治疗效果。
