Laparoscopic Repair of Primary Inguinal Hernia Performed in Public Hospitals or Low-Volume Centers Have Increased Risk of Reoperation for Recurrence

TY - JOUR

T1 - Laparoscopic Repair of Primary Inguinal Hernia Performed in Public Hospitals or Low-Volume Centers Have Increased Risk of Reoperation for Recurrence

AU - Andresen, Kristoffer

AU - Friis-Andersen, Hans

AU - Rosenberg, Jacob

N1 - © The Author(s) 2015.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background. Inguinal hernia repair is traditionally carried out as either open or laparoscopic repair. Laparoscopic repair has been shown to be superior in terms of pain and discomfort, but has a higher risk of reoperation. Quality of inguinal hernia repair is related to factors such as method of repair, characteristics of patients, and possibly the annual volume of procedures performed by a center. The aim of this study was to test the hypothesis that hospital volume and type of hospital (private vs public) could influence the reoperation rate for recurrence as a marker of surgical quality of care. Methods. This study was based on data from the Danish Hernia Database covering the period from January 1, 1998, to December 31, 2013. Hernia repairs included in this study were laparoscopic repair of primary, inguinal hernias in the elective setting, performed on adult male patients. Results. A total of 14 532 laparoscopic repairs were included for analysis. Centers reporting less than 50 procedures a year had a significantly higher cumulative reoperation rate compared with centers reporting more than 50 procedures a year (9.97% vs 6.06%), P <.0001. Private centers had a lower cumulative reoperation rate compared with public centers: 5.36% versus 8.53%, P ≤.0001. Type of center and center volume were both independent risk factors for reoperation in a Cox regression model. Conclusion. Hospital volume had an effect on the reoperation rate for recurrence after laparoscopic inguinal hernia repair. Furthermore, private centers performed better than public centers irrespective of volume.

AB - Background. Inguinal hernia repair is traditionally carried out as either open or laparoscopic repair. Laparoscopic repair has been shown to be superior in terms of pain and discomfort, but has a higher risk of reoperation. Quality of inguinal hernia repair is related to factors such as method of repair, characteristics of patients, and possibly the annual volume of procedures performed by a center. The aim of this study was to test the hypothesis that hospital volume and type of hospital (private vs public) could influence the reoperation rate for recurrence as a marker of surgical quality of care. Methods. This study was based on data from the Danish Hernia Database covering the period from January 1, 1998, to December 31, 2013. Hernia repairs included in this study were laparoscopic repair of primary, inguinal hernias in the elective setting, performed on adult male patients. Results. A total of 14 532 laparoscopic repairs were included for analysis. Centers reporting less than 50 procedures a year had a significantly higher cumulative reoperation rate compared with centers reporting more than 50 procedures a year (9.97% vs 6.06%), P <.0001. Private centers had a lower cumulative reoperation rate compared with public centers: 5.36% versus 8.53%, P ≤.0001. Type of center and center volume were both independent risk factors for reoperation in a Cox regression model. Conclusion. Hospital volume had an effect on the reoperation rate for recurrence after laparoscopic inguinal hernia repair. Furthermore, private centers performed better than public centers irrespective of volume.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Hernia, Inguinal

KW - Hospitals, Public

KW - Humans

KW - Kaplan-Meier Estimate

KW - Laparoscopy

KW - Male

KW - Middle Aged

KW - Reoperation

KW - Young Adult

KW - Journal Article

U2 - 10.1177/1553350615596636

DO - 10.1177/1553350615596636

M3 - Journal article

C2 - 26209630

SN - 1553-3506

VL - 23

SP - 142

EP - 147

JO - Surgical Innovation

JF - Surgical Innovation

IS - 2

ER -