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Variation in practice and outcomes after inguinal hernia repair: a nationwide observational study
BACKGROUND: Inguinal hernia repair has often been used as a showcase to illustrate practice variation in surgery. This study determined the degree of hospital variation in proportion of patients with an inguinal hernia undergoing operative repair and the effect of this variation on clinical outcomes...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816298/ https://www.ncbi.nlm.nih.gov/pubmed/33472620 http://dx.doi.org/10.1186/s12893-020-01030-0 |
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author | Latenstein, Carmen S. S. Thunnissen, Floris M. Harker, Mitchell Groenewoud, Stef Noordenbos, Mark W. Atsma, Femke de Reuver, Philip R. |
author_facet | Latenstein, Carmen S. S. Thunnissen, Floris M. Harker, Mitchell Groenewoud, Stef Noordenbos, Mark W. Atsma, Femke de Reuver, Philip R. |
author_sort | Latenstein, Carmen S. S. |
collection | PubMed |
description | BACKGROUND: Inguinal hernia repair has often been used as a showcase to illustrate practice variation in surgery. This study determined the degree of hospital variation in proportion of patients with an inguinal hernia undergoing operative repair and the effect of this variation on clinical outcomes. METHODS: A nationwide, longitudinal, database study was performed in all hospitals in the Netherlands between 2013 and 2015. Patients with inguinal hernias were collected from the Diagnosis-Related-Group (DRG) database. The case-mix adjusted operation rate in patients with a new DRG determines the observed variation. Hospital variation in case-mix adjusted inguinal hernia repair-rates was calculated per year. Clinical outcomes after surgery were compared between hospitals with high and low adjusted operation-rates. RESULTS: In total, 95,637 patients were included. The overall operation rate was 71.6%. In 2013–2015, the case-mix adjusted performance of inguinal hernia repairs in hospitals with high rates was 1.6–1.9 times higher than in hospitals with low rates. Moreover, in hospitals with high adjusted rates of inguinal hernia repair the time to surgery was shorter, more laparoscopic procedures were performed, less emergency department visits were recorded post-operatively, while more emergency department visits were recorded when patients were treated conservatively compared to hospitals with low adjusted operation rates. CONCLUSION: Hospital variation in inguinal hernia repair in the Netherlands is modest, operation-rates vary by less than two-fold, and variation is stable over time. Hernia repair in hospitals with high adjusted rates of inguinal hernia repair are associated with improved outcomes. |
format | Online Article Text |
id | pubmed-7816298 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-78162982021-01-21 Variation in practice and outcomes after inguinal hernia repair: a nationwide observational study Latenstein, Carmen S. S. Thunnissen, Floris M. Harker, Mitchell Groenewoud, Stef Noordenbos, Mark W. Atsma, Femke de Reuver, Philip R. BMC Surg Research Article BACKGROUND: Inguinal hernia repair has often been used as a showcase to illustrate practice variation in surgery. This study determined the degree of hospital variation in proportion of patients with an inguinal hernia undergoing operative repair and the effect of this variation on clinical outcomes. METHODS: A nationwide, longitudinal, database study was performed in all hospitals in the Netherlands between 2013 and 2015. Patients with inguinal hernias were collected from the Diagnosis-Related-Group (DRG) database. The case-mix adjusted operation rate in patients with a new DRG determines the observed variation. Hospital variation in case-mix adjusted inguinal hernia repair-rates was calculated per year. Clinical outcomes after surgery were compared between hospitals with high and low adjusted operation-rates. RESULTS: In total, 95,637 patients were included. The overall operation rate was 71.6%. In 2013–2015, the case-mix adjusted performance of inguinal hernia repairs in hospitals with high rates was 1.6–1.9 times higher than in hospitals with low rates. Moreover, in hospitals with high adjusted rates of inguinal hernia repair the time to surgery was shorter, more laparoscopic procedures were performed, less emergency department visits were recorded post-operatively, while more emergency department visits were recorded when patients were treated conservatively compared to hospitals with low adjusted operation rates. CONCLUSION: Hospital variation in inguinal hernia repair in the Netherlands is modest, operation-rates vary by less than two-fold, and variation is stable over time. Hernia repair in hospitals with high adjusted rates of inguinal hernia repair are associated with improved outcomes. BioMed Central 2021-01-20 /pmc/articles/PMC7816298/ /pubmed/33472620 http://dx.doi.org/10.1186/s12893-020-01030-0 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Latenstein, Carmen S. S. Thunnissen, Floris M. Harker, Mitchell Groenewoud, Stef Noordenbos, Mark W. Atsma, Femke de Reuver, Philip R. Variation in practice and outcomes after inguinal hernia repair: a nationwide observational study |
title | Variation in practice and outcomes after inguinal hernia repair: a nationwide observational study |
title_full | Variation in practice and outcomes after inguinal hernia repair: a nationwide observational study |
title_fullStr | Variation in practice and outcomes after inguinal hernia repair: a nationwide observational study |
title_full_unstemmed | Variation in practice and outcomes after inguinal hernia repair: a nationwide observational study |
title_short | Variation in practice and outcomes after inguinal hernia repair: a nationwide observational study |
title_sort | variation in practice and outcomes after inguinal hernia repair: a nationwide observational study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816298/ https://www.ncbi.nlm.nih.gov/pubmed/33472620 http://dx.doi.org/10.1186/s12893-020-01030-0 |
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