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Surgeon perspectives on the STITCH trial: a mixed methods study.

Steven L Cochrun1, Ivan Herbey2, Nataliya Ivankova3

  • 1Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 8Th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35294, USA. scochrun@uabmc.edu.

Surgical Endoscopy
|May 2, 2023
PubMed
Summary

Surgeons struggle to adopt evidence-based fascial closure techniques for incisional hernia prevention due to study limitations and peer influence. Further trials in diverse populations may boost confidence in implementing these methods.

Keywords:
Decision-makingFascial closureHernia preventionMixed methodsSmall bite technique

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Area of Science:

  • Surgical technique adoption
  • Hernia prevention strategies
  • Healthcare practice implementation science

Background:

  • Evidence-based strategies for preventing incisional hernias via fascial closure during laparotomy are well-documented but underutilized.
  • Factors impeding surgeons' adoption of these evidence-based fascial closure techniques are not well understood.

Purpose of the Study:

  • To explore and characterize the factors influencing surgeons' decision-making regarding fascial closure techniques.
  • To identify barriers and facilitators to adopting evidence-based practices for incisional hernia prevention.

Main Methods:

  • Employed an exploratory sequential mixed-methods design.
  • Administered a quantitative survey (n=139) based on the Theoretical Domain Framework.
  • Conducted qualitative semi-structured interviews (n=14) with practicing surgeons, followed by thematic analysis and data integration.

Main Results:

  • Surgeons' decision-making was influenced by perceived limitations of prior studies, applicability of findings, anecdotal evidence, and situational factors.
  • Peer influence and insufficient training significantly impacted surgeons' willingness to adopt the small bite technique for fascial closure.
  • Both quantitative and qualitative data revealed multifaceted influences on technique selection.

Conclusions:

  • Trial design limitations, peer influence, and patient-specific factors critically affect surgeons' choice of fascial closure technique.
  • Conducting future clinical trials in diverse patient populations is recommended to enhance surgeon confidence and promote the adoption of optimal techniques.