全州范围内质量改进协作项目中中型（4 - 6厘米）腹疝治疗方法的差异
Variation in approach for midsize (4-6cm) ventral hernias across a statewide quality improvement collaborative.
作者信息
Ehlers Anne P, Hallway Alex K, O'Neill Sean M, Fry Brian T, Howard Ryan A, Shao Jenny M, Englesbe Michael J, Dimick Justin B, Telem Dana A, Kim Grace J
机构信息
Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
出版信息
Surg Pract Sci. 2024 Jan 23;16:100235. doi: 10.1016/j.sipas.2024.100235. eCollection 2024 Mar.
INTRODUCTION
Repair of midsize (4-6 cm) ventral hernias is challenging given lack of guidelines. Within this context, we sought to characterize surgical approach among patients undergoing repair of midsize ventral hernias within the only population-level, clinically-nuanced hernia registry in the US.
METHODS
Retrospective cohort study of patients undergoing ventral hernia repair in the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC-COHR). MSQC-COHR is the only US population-level registry that captures clinically-nuanced data pertaining to patient hernia characteristics. We included patients who underwent repair of a 4-6 cm hernia from January 1, 2020-June 30, 2022. We stratified repair type as open or minimally invasive and used a multivariable logistic regression model to identify factors associated with MIS approach. Secondary outcomes included complications rate.
RESULTS
Among 771 patients, mean hernia width (SD) was 4.7 cm (0.8) and 339 (44 %) underwent MIS approach. Patients with MIS approach had lower BMI (33.5 vs 34.8, = 0.02) and less often were ASA class III (47.5% vs 54.6 %, = 0.02) or ASA class IV (2.4% vs 4.2 %, = 0.02). MIS approach was associated with smaller mean hernia width (4.71 cm vs 4.84 cm, = 0.02) and was used more often in the elective setting (94.4% vs 84.0 %, < 0.01). In the multivariable logistic regression model, higher BMI (aOR 0.97, 95 % CI 0.94-0.99) and urgent/emergent surgery (aOR 0.43, 95 % CI 0.24-0.79) were associated with lower odds of MIS. We found no significant association between MIS and risk of complications (aOR 0.62, 95 % CI 0.37-1.04). Among patients undergoing MIS, more than half ( = 236, 69.6 %) had a robotic approach but there were few patient factors associated with this.
CONCLUSION
Among patients with midsize hernias, few patient-level factors are associated with approach. This may indicate that surgeon preference factors largely into this decision.
引言
由于缺乏相关指南，修复中等大小（4 - 6厘米）的腹疝具有挑战性。在此背景下，我们试图在美国唯一的基于人群、具有临床细节的疝登记系统中，对接受中等大小腹疝修复手术的患者的手术方式进行特征描述。
方法
对密歇根外科质量协作核心优化疝登记系统（MSQC - COHR）中接受腹疝修复手术的患者进行回顾性队列研究。MSQC - COHR是美国唯一的基于人群的登记系统，可收集与患者疝特征相关的具有临床细节的数据。我们纳入了2020年1月1日至2022年6月30日期间接受4 - 6厘米疝修复手术的患者。我们将修复类型分为开放手术或微创手术，并使用多变量逻辑回归模型来确定与微创手术方式相关的因素。次要结局包括并发症发生率。
结果
在771例患者中，疝的平均宽度（标准差）为4.7厘米（0.8），339例（44%）接受了微创手术。接受微创手术的患者体重指数较低（33.5 vs 34.8，P = 0.02），ASAⅢ级（47.5% vs 54.6%，P = 0.02）或ASAⅣ级（2.4% vs 4.2%，P = 0.02）的情况也较少。微创手术方式与较小的平均疝宽度相关（4.71厘米 vs 4.84厘米，P = 0.02），并且在择期手术中使用更为频繁（94.4% vs 84.0%，P < 0.01）。在多变量逻辑回归模型中，较高的体重指数（调整后比值比0.97，95%置信区间0.94 - 0.99）和急诊/紧急手术（调整后比值比0.43，95%置信区间0.24 - 0.79）与接受微创手术的较低几率相关。我们发现微创手术与并发症风险之间无显著关联（调整后比值比0.62，95%置信区间0.37 - 1.04）。在接受微创手术的患者中，超过一半（n = 236，69.6%）采用了机器人手术方式，但与之相关的患者因素较少。
结论
在中等大小疝的患者中，很少有患者层面的因素与手术方式相关。这可能表明外科医生的偏好很大程度上影响了这一决策。
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