European Journal of Molecular & Clinical Medicine

Abstract

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.
Method: An unselected cohort of 223 patients who underwent laparoscopic totally extraperitoneal (TEP) inguinal hernia repair before March 2022 were included in this study, thus ensuring a minimum 5-year follow-up. Patient demographic data, clinical notes, operating notes and outpatient follow-up notes were studied. Patients were interviewed telephonically regarding hernia recurrence, chronic pain and technique preference if they had previously undergone an open repair. All data collected were recorded on an electronic spreadsheet.The primary outcome parameter was recurrence. The secondary outcome parameters were postoperative and long-term complications.
Results: This nationwide database study shows that practice variation in inguinal hernia repair is modest in the Babel province. Operation-rates vary by less than two-fold, and variation is stable over the years 2020-2022. A more thorough analysis illustrates that the type of hospital (academic, teaching, or private) is the most relevant factor contributing to the observed variation. An addition to previous reports on practice variation in hernia surgery is the present finding that adjusted rates in surgery in general hospitals are associated with the type of financial reimbursement for diagnosis and the percentage of self-employed staff. These non-clinical factors related to variation may not only contribute to practice variation in hernia surgery,
Conclusion :Hospital variation in inguinal hernia repair in the Al-hila city 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.