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Five year trends in surgical technique and outcomes of groin hernia repair in the United States

  • 2022 SAGES Oral
  • Published:
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Abstract

Introduction

Despite being one of the most commonly performed operations in the US, there is a paucity of data on practice patterns and resultant long-term outcomes of groin hernia repair. In this context, we performed a contemporary assessment of operative approach with 5 year follow-up to inform care for the 800000 persons undergoing groin hernia repair annually.

Methods

This was a retrospective cohort study of adult patients undergoing elective groin hernia repair in a 20% representative Medicare sample from 2010–17. Surgical approach [minimally invasive (MIS) vs open] was defined using appropriate CPT codes. The primary outcome was operative recurrence at up to 5 years following surgery. We estimated the overall risk of operative recurrence using a multivariable Cox proportional hazards model.

Results

Among 118119 patients, the majority (76.4%) underwent an open repair. Compared to patients who underwent MIS repair, patients in the open surgery cohort were older (mean age 72.7 vs 71.0, p < 0.001), more often female (14.4 vs 10.9%, p < 0.001), less often white (86.9 vs 87.7%, p < 0.001), and had a higher prevalence of nearly all measured comorbidities Patients in the open cohort had a lower incidence of operative recurrence at 1-year (1.0 vs 1.5%, p < 0.001), 3-years, (2.5 vs 3.5%, p < 0.001), and 5-years (3.7 vs 4.7%, p < 0.001). In the Cox proportional hazards model, we found that patients who underwent an open groin hernia repair were significantly less likely to experience operative recurrence (HR 0.86, 95% CI 0.79–0.93).

Conclusions

In this study, we found that open groin hernia repair was associated with a lower risk of operative recurrence over time. While this may be related to patient comorbidity and age at the index operation, future work should focus on the impact of surgeon volume on outcomes in the modern era.

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Funding

Society of American Gastrointestinal and Endoscopic Surgeons, Disparities in Healthcare Grant—Sex-Based Differences in Outcomes of Groin Hernia Repair, Anne Ehlers.

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Authors and Affiliations

  1. Department of Surgery, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, USA

    Anne P. Ehlers, Yen-Ling Lai, Hsou Mei Hu, Ryan Howard, Jennifer F. Waljee, Justin B. Dimick & Dana A. Telem

  2. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA

    Anne P. Ehlers, Ryan Howard, Jennifer F. Waljee, Justin B. Dimick & Dana A. Telem

  3. Department of Surgery, University of Washington, Seattle, WA, USA

    Giana H. Davidson

Authors
  1. Anne P. Ehlers
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  2. Yen-Ling Lai
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  3. Hsou Mei Hu
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  4. Ryan Howard
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  5. Giana H. Davidson
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  6. Jennifer F. Waljee
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  7. Justin B. Dimick
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  8. Dana A. Telem
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Corresponding author

Correspondence to Anne P. Ehlers.

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Disclosures

Ms. Lai, Dr. Hu, Dr. Davidson, and Dr. Waljee have no disclosures. Dr. Ehlers receives unrelated funding from the Association for Academic Surgeons and the Society for American Gastrointenstinal and Endoscopic Surgeons. Dr. Howard receives unrelated funding from the Blue Cross Blue Shield of Michigan Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK108740-05). Dr. Dimick receives grant funding from the NIH, AHRQ, Blue Cross Blue Shield of Michigan Foundation, and is a cofounder of ArborMetrix, Inc. Dr. Telem receives funding from AHRQ K08HS025778-01A1 and receives consulting fees from Medtronic. The content of this study is solely the responsibility of the authors. No funder or sponsor had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Dr. Ehlers had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Ehlers, A.P., Lai, YL., Hu, H.M. et al. Five year trends in surgical technique and outcomes of groin hernia repair in the United States. Surg Endosc 37, 4818–4823 (2023). https://doi.org/10.1007/s00464-022-09586-z

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  • DOI: https://doi.org/10.1007/s00464-022-09586-z

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