Exploration of Surgeon Motivations in Management of Abdominal Wall Hernias

Vitous, C. Ann; Jafri, Sara M.; Seven, Claire; Ehlers, Anne P.; Englesbe, Michael J.; Dimick, Justin B.; Telem, Dana A.

doi:10.1001/jamanetworkopen.2020.15916

Cited by 14 publications

(6 citation statements)

References 39 publications

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“…Also, the incidence rate of hernia is seen more frequently in male than in female. The choice of surgical treatment method depends on the localization of the hernia, the risk of complications development, and the postoperative recovery time as well as the choice of the patient [4,7,22,11,14,[16][17][18][19][20][21]. Also, with age hernia risk increases.…”

Section: Discussionmentioning

confidence: 99%

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Hernia surgical treatment; multi-options and paucity of statistical conformation for the preferred surgical option

Marzoog

Vladimirovich

2022

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Background: Hernia is a common pathology in the globe and reported more frequently, particularly, inguinal hernia. Aims: To identify the surgery of choice for the treatment of hernias by evaluating the required postoperative hospitalization time, as no other complications have been reported according to data from Mordovian Republic hospital. Material and methods: A retrospective cohort study involved 790 patients for the period 2017-2022 treated surgically for various types of hernia; inguinal hernia, umbilical hernia, spontaneously reduced strangulated post-operative ventral hernia, incarcerated post-operative ventral hernia, and hernia of the Lina Alba. For statistical analysis, used T test, one way ANOVA test, and Pearson correlation test by using Statistica program. Results: The hospitalization period after Lichtenstein surgery is statistically less than Postemsky surgery (mean 6.88 days, 7.43 days, respectively, t value -2.29593, p<0.02) and laparoscopic surgery (mean 6.88 days, 8.19072 days, respectively, t value 4,206817, p<0,000031). Whereas, Postemsky surgery has shorter post-operative hospitalization period in compare to laparoscopic surgery (mean 7.43 days, 8.19072 days, respectively, t value -2.19326, p<0.02). According to the used surgical approach, the patients post-operative hospitalization days differs (mean days: min. days; max. days, 7.50192: 0.00; 30.00). According to Postemsky (M m; 7.43262, 0.167012), according to Martynov (M m; 8.37500, 0.113440), according to Lichtenstein (M m; 6.88153, 0.146845), according to Mayo (M m; 7.51282, 0.280156), according to Bassini (M m; 8.77778, 2.379179), laparoscopically (M m; 8.19072, 0.268434), according to Sapezhko (M m; 8.25000, 1.380074), and another type of surgery (M m; 11.40000, 2.501999). Women (mean 8.525114 days) hospitalized longer than men (mean 7.065371 days), t value 5.871044, p< 0.001. A statistically significant correlation has been found between age and post-operative hospitalization time (Pearson Rank Order Correlations r=0.215561, p <0.05). Conclusions: The study shows that the Lichtenstein surgery is the surgery of choice in terms of hospitalization time after the surgery. Straight association between sex and age with postoperative hospitalization days.

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Section: Discussionmentioning

confidence: 99%

“…Hernia defined as a protrusion of the abdominal organs in another organ or through the abdominal wall as well as canals such as the inguinal canal [2]. In clinical practice, hernias are usually managed by strengthening the wall of the protruded tissue with mesh [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Hernia surgical treatment; multi-options and paucity of statistical conformation for the preferred surgical option

Marzoog

Vladimirovich

2022

Preprint

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“…While a variety of models and frameworks could have been chosen, this model was used because of its utility in probing the underlying determinants of behavior when implementing new practices, which might provide insights from stakeholders that could be operationalized to improve practices around vaccine administration in jail. Furthermore, use of the TDF has supported the development of techniques that result in evidence-based behavior change, particularly at the individual level [18,19]. Using this framework allowed us to propose evidencebased strategies for behavior change among HSAs that could increase vaccination rates of both staff and incarcerated individuals in MA jails.…”

Section: Methodsmentioning

confidence: 99%

“The bottom line is that it is all about trust”: Interviews with Health Services Administrators about perceived barriers and facilitators to vaccine administration in jails

Cassarino¹,

Lodolo²,

Smyth³

et al. 2023

J. Clin. Trans. Sci.

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Background: Compared to the general population, individuals incarcerated in jails and prisons are more vulnerable to infection and mortality from communicable diseases, such as COVID-19 and influenza. However, vaccination rates among incarcerated individuals as well as staff who work in jails and prisons remain disproportionately low. Healthcare administrators working in jails have first-hand experience about barriers to vaccine provision, but their perspectives are infrequently collected and analyzed. Methods:We reached out to Health Services Administrators (HSAs) from all 14 Massachusetts (MA) county jails for qualitative in-depth interviews to understand how their personal and professional feelings about vaccination relate to the barriers and facilitators that surround administration of vaccines in jail. Results:Eight people participated in the study (8/14= 57% response rate). Key themes emerged, including 1) HSAs expressed divergent opinions on incarceration as the correct opportunity to vaccinate individuals, 2) HSAs' personal views on vaccines influenced their operationalization of vaccination in jail and 3) opinions varied on whether their institutions' vaccine protocols needed modification. Conclusions:Our findings highlight the critical need to leverage the feedback and influence of stakeholders such as HSAs in efforts to improve preventative healthcare delivery in carceral health systems.

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“…Interviews were conducted independently by telephone or in person. Some themes elicited from these interviews have been described previously; however, the present study specifically explores the elicited barriers in more detail as part of a stepwise implementation strategy …”

Section: Methodsmentioning

confidence: 99%

“…Some themes elicited from these interviews have been described previously; however, the present study specifically explores the elicited barriers in more detail as part of a stepwise implementation strategy. 27 After these interviews, a multidisciplinary hernia task force was convened consisting of 25 experts in hernia surgery, pain management, anesthesia, quality improvement, data abstraction, and implementation. Participants were recruited based on existing networks within the MSQC with the purpose of improving the care of patients with hernia in Michigan.…”

Section: Identifying Evidence-based Implementation Strategiesmentioning

confidence: 99%

Development and Implementation of Preoperative Optimization for High-Risk Patients With Abdominal Wall Hernia

et al. 2021

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IMPORTANCE Real-world surgical practice often lags behind the best scientific evidence. For example, although optimizing comorbidities such as smoking and morbid obesity before ventral and incisional hernia repair improves outcomes, as many as 25% of these patients have a high-risk characteristic at the time of surgery. Implementation strategies may effectively increase use of evidence-based practice.OBJECTIVE To describe current trends in preoperative optimization among patients undergoing ventral hernia repair, identify barriers to optimization, develop interventions to address these barriers, and then pilot these interventions. DESIGN, SETTING, AND PARTICIPANTSThis quality improvement study used a retrospective medical record review to identify hospital-level trends in preoperative optimization among patients undergoing ventral and incisional hernia repair. Semistructured interviews with 21 practicing surgeons were conducted to elicit barriers to optimizing high-risk patients before surgery. Next, a task force of experts was convened to develop pragmatic interventions to increase surgeon use of preoperative optimization. Finally, these interventions were piloted at 2 sites to assess acceptability and feasibility. This study was performed from January 1, 2014, to December 31, 2019. MAIN OUTCOMES AND MEASURESThe main outcome was rate of referrals for preoperative patient optimization at the 2 pilot sites. RESULTS Among 23 000 patients undergoing ventral hernia repair, the mean (SD) age was 53.9 (14.3) years, and 12 315 (53.5%) were men. Of these, 8786 patients (38.2%) had at least 1 high-risk characteristic at the time of surgery, including 7683 with 1, 1079 with 2, and 24 with 3. At the hospital level, the mean proportion of patients with at least 1 of 3 high-risk characteristics at the time of surgery was 38.2% (95% CI, 38.1%-38.3%). This proportion varied widely from 21.5% (95% CI, 17.6%-25.5%) to 52.8% (95% CI, 43.9%-61.8%) across hospitals. Interviews with surgeons identified 3 major barriers to improving this practice: lost financial opportunity by not offering a patient an operation, lack of surgeon awareness of available resources for optimization, and organizational barriers. A task force therefore developed 3 interventions: a financial incentive to optimize high-risk patients, an educational intervention to make surgeons aware of available optimization resources, and on-site facilitation. These strategies were piloted at 2 sites where preoperative risk optimization referrals increased 860%. CONCLUSIONS AND RELEVANCEThis study demonstrates a stepwise process of identifying a practice gap, eliciting barriers that contribute to this gap, using expert consensus and local resources to develop strategies to address these barriers, and piloting these strategies. This implementation (continued) Key Points Question Is a stepwise implementation intervention associated with increased use of preoperative optimization by surgeons for patients with abdominal wall hernia? Findings In this quality improvement study in...

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Exploration of Surgeon Motivations in Management of Abdominal Wall Hernias

Cited by 14 publications

References 39 publications

Hernia surgical treatment; multi-options and paucity of statistical conformation for the preferred surgical option

Hernia surgical treatment; multi-options and paucity of statistical conformation for the preferred surgical option

“The bottom line is that it is all about trust”: Interviews with Health Services Administrators about perceived barriers and facilitators to vaccine administration in jails

Development and Implementation of Preoperative Optimization for High-Risk Patients With Abdominal Wall Hernia

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