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.

Graphical abstract

中文翻译：

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美国腹股沟疝修补手术技术和结果的五年趋势

介绍

尽管是美国最常进行的手术之一，但关于腹股沟疝修补术的实践模式和由此产生的长期结果的数据很少。在这种情况下，我们对手术方法进行了当代评估，并进行了 5 年的随访，以告知每年接受腹股沟疝修补术的 800000 人的护理。

方法

这是一项针对 2010-17 年 20% 代表性医疗保险样本中接受择期腹股沟疝修补术的成年患者的回顾性队列研究。使用适当的 CPT 代码定义手术方法 [微创 (MIS) 与开放]。主要结果是手术后长达 5 年的手术复发。我们使用多变量 Cox 比例风险模型估计了手术复发的总体风险。

结果

在 118119 名患者中，大多数 (76.4%) 接受了开放修复。与接受 MIS 修复的患者相比，开放手术队列中的患者年龄较大（平均年龄 72.7 对 71.0，p  < 0.001），女性较多（14.4 对 10.9%，p  < 0.001），白人较少（86.9 对 87.7%） , p  < 0.001)，并且几乎所有测量的合并症的患病率都更高 开放队列中的患者在 1 年（1.0 对 1.5%，p < 0.001）、3 年（2.5 对3.5%，p  < 0.001）和 5 年（3.7 对 4.7%，p < 0.001)。在 Cox 比例风险模型中，我们发现接受腹股沟疝修补术的患者手术复发的可能性显着降低（HR 0.86，95% CI 0.79–0.93）。

结论

在这项研究中，我们发现随着时间的推移，开放性腹股沟疝修补术与较低的手术复发风险相关。虽然这可能与患者合并症和指数手术时的年龄有关，但未来的工作应该关注外科医生数量对现代结果的影响。

图形概要