Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair

Area of Science:

• Surgical quality and outcomes research
• Health disparities research
• Minimally Invasive Surgery (MIS)

Background:

• Black patients and older adults are less likely to receive minimally invasive hernia repair.
• Surgeon-specific utilization rates of minimally invasive repair may influence these disparities.
• This study investigates the role of surgeon utilization in MIS receipt for inguinal hernia repair.

Purpose of the Study:

• To explore the association between patient race, age, and surgeon utilization of minimally invasive surgery (MIS).
• To determine the likelihood of receiving MIS inguinal hernia repair based on these factors.
• To identify potential mediators and independent factors contributing to disparities in MIS adoption.

Main Methods:

• Retrospective cohort study of elective primary inguinal hernia repair patients (2012-2016).
• Data sourced from the Michigan Surgical Quality Collaborative (72-hospital registry).
• Hierarchical logistic regression models used to analyze associations between MIS receipt, race, age, and surgeon MIS utilization.

Main Results:

• 27% of 4667 patients received MIS repair; 43% of 190 surgeons performed only open repair.
• Controlling for surgeon utilization, race was not significantly associated with MIS receipt (OR 0.93, p=0.775).
• Older patients were significantly less likely to receive MIS repair (OR 0.41, p<0.001), independent of surgeon utilization.

Conclusions:

• Racial disparities in MIS hernia repair access were explained by surgeon MIS utilization rates.
• Age disparities in MIS receipt were independent of surgeon utilization, suggesting provider bias against older patients.
• Interventions should focus on improving access to MIS and educating providers and patients about its benefits for older adults.