Impact of ultrasound on inguinal hernia repair rates in Australia: a population‐based analysis

Abstract

Background Inguinal hernias are a common pathology that often requires surgical management. The use of groin ultrasound (GU) to investigate inguinal hernias is a growing area of concern as an inefficient use of healthcare resources. Our aim was to assess changes in the rates of GU and the impact on surgical practice. Methods Medicare Item Reports and the Australian Institute of Health and Welfare Database were used to estimate annual GU and inguinal hernia repair (IHR) rates per 100 000 population for the period 2000/2001–2017/2018. Pearson's correlation coefficients and linear regression analyses were performed to assess associations between these variables. Results Over the 18‐year period, GU rates increased 13‐fold from 88 to 1174 per 100 000 population. Overall, total IHR rates decreased from 217 to 192 per 100 000. Overall, unilateral IHR rates have decreased (182–146 per 100 000), bilateral IHRs have increased (35–46 per 100 000), laparoscopic IHR has increased (30–86 per 100 000) and open surgery has declined (187–106 per 100 000). The increase in GU rates were strongly associated with the decrease in unilateral (r = −0.936, P = <0.001) and increase in bilateral IHR rates (r = 0.924, P = <0.001). Conclusion The use of GU has increased substantially, potentially representing an unnecessary cost to the healthcare system. Rising GU rates are not associated with an increase in IHR, however, may contribute to the increasing rates of bilateral IHRs. This study supports the opinion that more extensive clinical and health policy initiatives are needed in Australia to address this health issue.

Choosing wisely: how wisely do we choose?

“…This is an example where a 'top down' approach could be used to regulate unnecessary ultrasound examination, if the item number for groin ultrasound for inguinal hernia assessment is limited by the regulator. 11 With our ageing population and health care spending at an alltime high, it is time that we, as a profession, do more to drive a 'bottom up' approach before our government and regulators do it for us. A failure to do so, may take more away from patient care than we like.…”

“…This is an example where a ‘top down’ approach could be used to regulate unnecessary ultrasound examination, if the item number for groin ultrasound for inguinal hernia assessment is limited by the regulator 11 …”