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Pediatric Surgeons' Adoption of an Innovative Laparoscopic Technique for Inguinal Hernia Repair: A Mixed Methods
Andrea Altschuler1, Albert J Chong2, Mubarika Alavi1
1Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
Insights
Pediatric surgeons adopted a new laparoscopic hernia repair technique, showing low recurrence rates. The study explored surgeon learning and departmental influences on adopting surgical innovations.
Area of Science:
- Pediatric Surgery
- Surgical Innovation Adoption
- Health Services Research
Background:
- Evidence supports an innovative laparoscopic technique for pediatric inguinal hernia repair.
- Understanding surgeon adoption of new surgical techniques is crucial for practice improvement.
Purpose of the Study:
- To study the adoption of an innovative laparoscopic technique for pediatric inguinal hernia repair.
- To examine surgeon adoption, recurrence rates, and factors influencing the uptake of surgical innovations.
Main Methods:
- Mixed methods study involving children undergoing inguinal hernia repair (2017-2019) and their surgeons.
- Analysis of recurrence and contralateral repair rates.
- In-depth interviews with surgeons to explore attitudes and practices regarding surgical innovation adoption.
Main Results:
- Low ipsilateral recurrence rates (1.54% unilateral, 0.50% bilateral) for the innovative technique compared to open repairs.
- Fewer metachronous contralateral repairs (0.44%) with the innovative technique versus open repairs (1.63%).
- Surgeon interviews revealed themes of continued learning, departmental culture, and technical considerations.
Conclusions:
- The innovative laparoscopic technique demonstrates favorable outcomes in pediatric inguinal hernia repair.
- Surgeon and departmental factors significantly influence the adoption speed of new surgical techniques.
- A collegial learning model, similar to surgical training, aids in adopting evidence-based innovations.
Abstract:
We studied adoption of an innovative laparoscopic technique for pediatric inguinal hernia repair by pediatric surgeons and pediatric urologists following dissemination of evidence for its benefits. This mixed methods study included children who received inguinal hernia repairs during 2017-2019 and their surgeons. We examined surgeons' adoption and use of the innovative technique and rates of ipsilateral recurrence and metachronous contralateral repair. In-depth interviews with surgeons were used to identify themes regarding attitudes and practices regarding the adoption of surgical innovations. No ipsilateral recurrences were noted among open repairs after 1.5 years of average follow-up, while 1.54% (7/453) of unilateral and 0.50% (3/606 sides) of bilateral innovative surgeries required ipsilateral repair after 1.3 years of average follow-up. Among unilateral cases, metachronous contralateral repairs were performed in 1.63% (8/490) of open and 0.44% (2/453) of innovative surgeries. Surgeon interviews identified approaches to continued learning and change; the role of departmental culture, norms, and resources; and technical issues specific to pediatric surgery and pediatric inguinal hernia repair. Outcomes may have improved over time as a consequence of learning. Differences among surgeons and departments influenced the speed of adoption. Surgeons linked the collegial model used when adopting the new technique to the apprenticeship model used during their training. We propose research into the collegial model to improve translation of evidence-based surgical innovations into practice. Level III.
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