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

Abstract

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.

Potential influencing factors on the outcome in incisional hernia repair: a registry-based multivariable analysis of 22,895 patients

“…In the current analysis, prospective data of patients who underwent primary elective incisional hernia repair with the laparoscopic intraperitoneal onlay mesh (IPOM) technique or open suture, sublay, onlay, or IPOM approach were evaluated to assess all confirmatory pre-defined potential influencing factors on the perioperative and 1-year follow-up outcomes. Here, the focus in particular was to assess the role of EHS width classification W1 (< 4 cm), W2 (≥ 4 cm–10 cm), W3 (> 10 cm) on the outcome [ 16 ]. Further variables to be assessed were age in years, BMI in kg/m 2 , gender, ASA score, surgical technique, preoperative pain (yes, no, unknown), drainage (yes, no), EHS classification (medial, lateral, combined), presence of risk factors (yes, no), and postoperative complications (yes, no) on analysis of pain at follow-up.…”

“…Registry and database analyses reported in the literature make several references to factors that have an unfavorable influence on the outcome following incisional hernia repair [ 12 – 16 ]. These unfavorable factors, include age, gender, risk factors, open surgical procedures, defect width, body mass index (BMI) ≥ 30 kg/m 2 ), and smoking [ 12 – 16 ].…”

“…Registry and database analyses reported in the literature make several references to factors that have an unfavorable influence on the outcome following incisional hernia repair [ 12 – 16 ]. These unfavorable factors, include age, gender, risk factors, open surgical procedures, defect width, body mass index (BMI) ≥ 30 kg/m 2 ), and smoking [ 12 – 16 ]. Recently, an analysis of the data of 2191 patients from the French Hernia Registry “Club Hernie” showed that larger defect widths, as classified by the European Hernia Society (EHS) [ 17 ], had an unfavorable impact on the postoperative complication rate [ 15 ].…”

The inguinal hernia management in Costa Rica according to a survey between surgeons: result comparison with 2018 International Groin Hernia Guidelines

“…Our surgeons showed to have a high-volume IH repair, described as more than 25 IH repair per year per surgeon, or more than 126 IH repair per year in one hospital. A high-volume surgeon has better results related to recurrence, complications and re operations [ 13 , 14 ].…”

National Survey on the management of inguinal hernia in Spain. Comparison of results with the international guide of The Hernia Surge Group

“…Se sabe que los cirujanos que realizan un alto volumen de hernioplastias inguinales tienen mejores resultados en cuanto a recidiva, complicaciones y reoperaciones. Un estudio comparativo en el 2015 demostró lo anterior, pero definiendo el alto volumen con más de 25 hernioplastias inguinales por año por cirujano, y otro del 2019 indica lo mismo, pero indicando que un hospital de alto volumen realiza más de 126 HI por año19,20 . mujer, el 94.8 % no hacía un abordaje diferente por estar tratando con mujeres, sino que seguían el mismo tipo de cirugía que hacían en el hombre, obviando la recomendada obliteración del orificio miopectíneo femenino1 .Un énfasis que debe hacerse es que el 38 % de nuestros cirujanos sigue usando el tapón similar a la técnica de Rutkow Robbins22 .…”