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Explaining variation in ventral and inguinal hernia repair outcomes: A population-based analysis
Christopher T Aquina1, Fergal J Fleming1, Adan Z Becerra2
1Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY.
Surgery
|May 23, 2017
Summary
Surgeon factors, not hospital factors, drive most hernia reoperation rate variations. Identifying these surgeon-specific attributes is key to improving hernia repair outcomes and reducing recurrence rates.
Area of Science:
- Surgical outcomes research
- Health services research
- Hernia repair analysis
Background:
- Variation in hernia reoperation rates exists, but the relative importance of patient, surgeon, and hospital factors remains unevaluated.
- Understanding these factors is crucial for improving surgical quality and patient outcomes after hernia repair.
Purpose of the Study:
- To evaluate the relative importance of patient, surgeon, and hospital factors on surgeon and hospital variation in hernia reoperation rates.
- To identify factors associated with reoperation for recurrence after ventral and inguinal hernia repair.
Main Methods:
- Population-based retrospective cohort study utilizing New York state data (2003-2009).
- Included 78,267 ventral hernia repairs and 124,416 inguinal hernia repairs.
- Mixed-effects Cox proportional hazards analyses assessed 5-year reoperation rates for hernia recurrence.
Main Results:
- The majority of variation in reoperation rates is surgeon-level (87% for ventral, 92% for inguinal hernia repairs).
- Patient factors, mesh placement, and surgeon volume/certification explained only a small portion of surgeon variation.
- A significant portion (67% for ventral, 89% for inguinal) of surgeon variation remained unexplained.
Conclusions:
- Surgeon-level variation is the primary driver of reoperation rates after hernia repair.
- Hernia recurrence may serve as a surgeon quality metric.
- Further research is needed to identify the specific surgeon attributes contributing to this significant variation.
