Evolving Inguinal Hernia Repair Practice at the Veterans Health Administration

Area of Science:

• Surgical outcomes and trends
• Health services research
• Veterans health

Background:

• Inguinal hernia repair (IHR) is a common surgical procedure, with US veterans presenting unique demographic and comorbidity profiles.
• Previous research on IHR trends has largely focused on civilian populations, leaving a gap in understanding veteran-specific patterns.
• Advancements in IHR techniques necessitate updated analyses of their adoption and impact within the Veterans Health Administration (VHA).

Purpose of the Study:

• To analyze trends in the volume and surgical approach of inguinal hernia repair (IHR) within the VHA over a 20-year period.
• To examine changes in procedural urgency and surgical setting for IHR among veterans.
• To provide insights into the evolving surgical landscape for a significant veteran health concern.

Main Methods:

• A retrospective cohort study utilizing national VHA data from 2002 to 2022.
• Identification of veterans undergoing IHR using Corporate Data Warehouse procedure and diagnosis codes.
• Analysis of surgical volumes, approach (open vs. minimally invasive - MIS), urgency, and setting.

Main Results:

• A total of 308,876 IHRs were performed in the VHA between 2002 and 2022, predominantly in male veterans with high rates of comorbidities.
• The overall volume of IHRs increased, with a substantial rise in minimally invasive approaches (MIS-IHR) from 9.2% to 41.0%.
• Urgent/emergent procedures were more common in community settings compared to VHA facilities, and women were more likely to receive MIS-IHR and urgent/emergent procedures.

Conclusions:

• The VHA has experienced a significant increase in inguinal hernia repair (IHR) volume and a marked shift towards minimally invasive surgery (MIS) over the past two decades.
• These findings highlight the adaptation of surgical practices within the VHA to meet the needs of the veteran population.
• IHR remains a substantial surgical undertaking within the veteran population, underscoring the importance of continued monitoring and research into optimal care strategies.