Substantial variation among hernia experts in the decision for treatment of patients with incisional hernia: a descriptive study on agreement

TY - JOUR

T1 - Substantial variation among hernia experts in the decision for treatment of patients with incisional hernia

T2 - a descriptive study on agreement

AU - Kokotovic, D

AU - Gögenur, I

AU - Helgstrand, F

PY - 2017/4/1

Y1 - 2017/4/1

N2 - PURPOSE: Benign elective procedures give rise to heterogeneity in indication for surgery and surgical technique among specialized surgeons in a variety of surgical fields. The objective was to analyze the extent of agreement in surgical management among expert hernia surgeons when evaluating the same patient in a standardized setting.METHODS: Five Danish hernia experts answered questions concerning indication for surgery and surgical technique for 25 video recorded real-life clinical cases. The experts evaluated the patients by answering a standardized questionnaire.RESULTS: All surgeons were experienced in incisional hernia repair with a median of 253 repairs (range 164-450 repairs). Perfect overall agreement among all the experts in indication, operation type, component separation, mesh fixation and mesh position was found in only five cases (20%). Agreement in indication for surgery was present in 14 cases (56%). The most common reason for not performing surgery was due to comorbidities. Agreement in operation type (open vs. laparoscopic) was present in 10 cases (40%). Agreement in mesh fixation (absorbable tacks/non-absorbable tacks/suture/other) method was also present in 10 cases (40%). Agreement in mesh position (onlay, sublay or intraperitoneal) was found in 40% of cases. The highest overall agreement among the surgeons was observed with regard to whether patients needed component separation (yes/no), 21 cases, (84%).CONCLUSIONS: In a standardized setting, agreement in choice of treatment strategy for patients with incisional hernias was very low among experienced surgeons. A standardization of surgical decision making is desirable to develop new interventions and improve clinical outcomes.

AB - PURPOSE: Benign elective procedures give rise to heterogeneity in indication for surgery and surgical technique among specialized surgeons in a variety of surgical fields. The objective was to analyze the extent of agreement in surgical management among expert hernia surgeons when evaluating the same patient in a standardized setting.METHODS: Five Danish hernia experts answered questions concerning indication for surgery and surgical technique for 25 video recorded real-life clinical cases. The experts evaluated the patients by answering a standardized questionnaire.RESULTS: All surgeons were experienced in incisional hernia repair with a median of 253 repairs (range 164-450 repairs). Perfect overall agreement among all the experts in indication, operation type, component separation, mesh fixation and mesh position was found in only five cases (20%). Agreement in indication for surgery was present in 14 cases (56%). The most common reason for not performing surgery was due to comorbidities. Agreement in operation type (open vs. laparoscopic) was present in 10 cases (40%). Agreement in mesh fixation (absorbable tacks/non-absorbable tacks/suture/other) method was also present in 10 cases (40%). Agreement in mesh position (onlay, sublay or intraperitoneal) was found in 40% of cases. The highest overall agreement among the surgeons was observed with regard to whether patients needed component separation (yes/no), 21 cases, (84%).CONCLUSIONS: In a standardized setting, agreement in choice of treatment strategy for patients with incisional hernias was very low among experienced surgeons. A standardization of surgical decision making is desirable to develop new interventions and improve clinical outcomes.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Comorbidity

KW - Contraindications

KW - Decision Making

KW - Elective Surgical Procedures

KW - Female

KW - Hernia, Ventral/surgery

KW - Herniorrhaphy/methods

KW - Humans

KW - Incisional Hernia/surgery

KW - Laparoscopy

KW - Male

KW - Middle Aged

KW - Recurrence

KW - Surgical Mesh

KW - Surveys and Questionnaires

U2 - 10.1007/s10029-016-1562-y

DO - 10.1007/s10029-016-1562-y

M3 - Journal article

C2 - 27915385

SN - 1265-4906

VL - 21

SP - 271

EP - 278

JO - Hernia : the journal of hernias and abdominal wall surgery

JF - Hernia : the journal of hernias and abdominal wall surgery

IS - 2

ER -