Comparing routine administrative data with registry data for assessing quality of hospital care in patients with inguinal hernia

Köckerling, F.; Maneck, M; Günster, Christian; Adolf, Daniela; Hukauf, Martin

doi:10.1007/s10029-019-02009-4

Cited by 13 publications

(6 citation statements)

References 17 publications

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“…The present study of routine administrative data from the German Local General Sickness Fund "AOK" [15] aimed to identify whether a correlation could be identified between the hospital volume and outcome.…”

Section: Introductionmentioning

confidence: 99%

Hospital volume and outcome in inguinal hernia repair: analysis of routine data of 133,449 patients

Maneck

Köckerling

Fahlenbrach

et al. 2019

Hernia

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Introduction Inguinal hernias are repaired using either open or minimally invasive surgical techniques. For both types of surgery it has been demonstrated that a higher annual surgeon volume is associated with a lower risk of recurrence. This present study investigated the volume-outcome implications for recurrence operations, surgical complications, rate of chronic pain requiring treatment, and 30-day mortality based on the hospital volume. Materials and methods The data basis used was the routine data collected throughout the Federal Republic of Germany for persons insured by the Local General Sickness Fund "AOK" who had undergone inpatient inguinal hernia repair between 2013 and 2015. Complications were recorded by means of indicators. Hospitals were divided into five groups on the basis of the annual caseload volume: 1-50, 51-75, 76-100, 101-125, and ≥ 126 inguinal hernia repairs per year. The effect of the hospital volume on the indicators was assessed using multiple logistic regression. Results 133,449 inguinal hernia repairs were included. The incidence for recurrence operations was 0.95%, for surgical complications 4.22%, for chronic pain requiring treatment 2.87%, and for the 30-day mortality 0.28%. Low volume hospitals (1-50 and 51-75 inguinal hernia repairs per year) showed a significantly increased recurrence risk compared to high volume hospitals with ≥ 126 inguinal hernia repairs per year (odds ratio: 1.53 and 1.24). No significant correlations were found for the other results. Conclusions The study gives a detailed picture of hospital care for inguinal hernia repair in Germany. Furthermore, it was noted that the risk of hernia recurrence decreases in line with a rising caseload of the treating hospital.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Introductionmentioning

confidence: 99%

Hospital volume and outcome in inguinal hernia repair: analysis of routine data of 133,449 patients

Maneck

Köckerling

Fahlenbrach

et al. 2019

Hernia

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“…In contrast to inguinal hernia surgery in adults [ 8 , 9 ], routine administrative data have been seldom used for paediatric inguinal hernia surgery. The ratio of male and female inguinal hernias was concordant with previous reports: There numbers of inguinal hernias in males were almost four times higher than in females whose hernias were more often incarcerated than those in boys [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic inguinal hernia repair was—unlike in adults [ 9 ]—rare in children and was only increasingly used in females older than 1 year of age. While earlier, smaller, comparisons of the open and laparoscopic approaches using unmatched data reported favourable outcomes for the laparoscopic procedure [ 42 ], a recent study employed propensity-matching and described several downsides of the laparoscopic approach such as always longer anaesthesia times for both uni- and bilateral inguinal hernia repairs and much higher recurrence rate compared to the open approach [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…The Swedish registry data has so far only been used to investigate specific narrow research questions in adolescents [ 5 ], as has a large insurance database in Japan [ 6 ]. Contrary to this situation in paediatric inguinal hernia repair, research in adults may not only rely on large-scale registries from different countries [ 7 ], but also on routine administrative data [ 8 ] and even the combination of both [ 9 ]. Just recently, the epidemiology of inguinal hernia repair in children has been described for the United States of America [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data

et al. 2021

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Background Contrary to adult inguinal hernia surgery, large-scale investigations using registries or administrative data are missing in paediatric surgery. We aimed to fill this gap by analysing German administrative hospital data to describe the current reality of inpatient hernia surgery in children. Methods We analysed aggregated data files bought from the German federals statistics office on hospital reimbursement data separately for principal diagnoses of inguinal hernia in children and for herniotomies in inpatients. Developments over time were assessed via regression and differences between groups with nonparametric comparisons. Results Principal diagnoses of hernias were decreasing over time with the exception of male bilateral and female bilateral incarcerated hernias in the first year of life which increased. The vast majority of operations were conducted via the open approach and laparoscopy was increasingly only used for females older than 1 year of age. Recurrent hernia repair was scarce. Rates of inguinal hernia repair were higher in both sexes the younger the patient was, but were also decreasing in all age groups despite a population growth since 2012. The amount of inguinal hernia repairs by paediatric surgeons compared to adult surgeons increased by 1.5% per year. Conclusions Our results corroborate previous findings of age and sex distribution. It demonstrates that inpatient hernia repair is primarily open surgery with herniorrhaphy and that recurrences seem to be rare. We observed decreasing rates of hernia repairs over time and as this has been described before in England, future studies should try to elucidate this development. Level of evidence III.

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“…As we conducted this study as a pilot trial, we decided to set a postoperative follow-up period of 30 days to gain information about adherence for further trials. As the risk for postoperative SSI in clean procedures is negligible [18,19], we asked participants to send wound pictures only for 7 days after surgery. Furthermore, they were free to take pictures of a suspected wound infection as they wanted.…”

Section: Measurement Of Parametersmentioning

confidence: 99%

Perioperative Tablet-Based Telemonitoring After Abdominal Wall Hernia Surgery: Pilot Prospective Observational Cohort Study (Preprint)

Gräfitsch¹,

Kirchhoff²,

Hoffmann³

et al. 2019

Preprint

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BACKGROUND The economic burden of general surgical procedures is a major contributor to health costs all over the world. To reduce these costs and to enhance patient comfort, more and more procedures are transferred to a daycase setting, already e.g. hernias of the abdominal wall are repaired without keeping the patient overnight in a lot of countries. In the future, it is very likely that more complex procedures are considered to be safe to be carried out this way too. Up to now, we cannot offer our patients any intensified monitoring, once they have left the hospital. Tablet-based telemonitoring seems to be a promising way to change this situation. OBJECTIVE The rationale for this study was to evaluate the feasibility of monitoring postoperative activity with a telemonitoring device after minor surgery of the abdominal wall. METHODS Patients aged 18 and older, scheduled for elective surgical repair of abdominal wall hernias were equipped with a telemonitoring system including a tablet, a pulse-oximeter and an actimeter for a monitoring phase of one week before and five weeks after surgery. The primary objective was the feasibility of monitoring postoperative activity, secondary objectives were monitoring of pain and the impact of wound photographs for surveillance and early detection of surgical site infections (SSI). RESULTS We enrolled 16 patients (5 (31.3%) female, 11 (68.8%) male) with an age of mean±SD (Standard Deviation) 48.75 ± 16.28 between October 2017 and September 2018 in our center. Regarding our primary objective, we were able to gather information relating to the patient activity levels in all patients, except one. This resulted in a response rate of 75 percent in the preoperative week, with declining rates over the follow-up period. The gathered steps per week showed broad variations over the study period with e.g. in the preoperative week mean±SD 27951.00 ± 21036.56 steps, mean±SD 1523.17 ± 9345.58 in the 1st postoperative week and mean±SD 21019 ± 15865.21 steps in the 5th postoperative week. Regarding the secondary objectives, the maximum VAS was mean±SD 4,24 ± 1,81 with a duration of transferred VAS-data of mean±SD 14,19 ± 8,67 days postoperatively. In the first week after the operation, VAS-data was transferred completely on 1 to 6 days, but the rate continuously decreased over the following four weeks, resulting in no data transmission at all in 62,5 percent of the cases in the 5th week. There occurred no SSI during the follow-up period. CONCLUSIONS Our study showed, in principle, the feasibility of a tablet-based follow-up after repair of small hernias of the abdominal wall. Further studies should target to optimize technical issues and focus on general surgical procedures with a higher potential for postoperative complications to evaluate a possible reduction of their impact due to earlier recognition. Moreover, smaller gadgets and mobile phones could be utilized. CLINICALTRIAL Nil

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Comparing routine administrative data with registry data for assessing quality of hospital care in patients with inguinal hernia

Cited by 13 publications

References 17 publications

Hospital volume and outcome in inguinal hernia repair: analysis of routine data of 133,449 patients

Hospital volume and outcome in inguinal hernia repair: analysis of routine data of 133,449 patients

Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data

Perioperative Tablet-Based Telemonitoring After Abdominal Wall Hernia Surgery: Pilot Prospective Observational Cohort Study (Preprint)

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