Inguinal hernia repair in Spain. A population-based study of 263,283 patients: factors associated with the choice of laparoscopic approach

Guillaumes, Salvador; Hoyuela, Carlos; Hidalgo, Nils Jimmy; Juvany, Montserrat; Bachero, Irene; Ardid, Jordi; Martrat, Antoni; Trias, M

doi:10.1007/s10029-021-02402-y

Cited by 18 publications

(12 citation statements)

References 40 publications

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“…In contrast, reimbursement covers the cost of laparoscopic surgery for inpatient hernia repair [ 30 ]. In Spain, where laparoscopic surgery is still a minority [ 14 ], we found a significantly lower percentage of outpatient surgeries, and only 38.8% of laparoscopic repairs were outpatient cases. We hope that the future development of laparoscopic surgery, a technique that favours outpatient surgery [ 27 ], will be an incentive rather than an impediment to expanding the number of outpatient surgeries.…”

Section: Discussionmentioning

confidence: 83%

“…Spain, like other countries, has a mandatory national hospital patient discharge registry, the National Minimum Basic Dataset (CMBD, Spanish acronym for Conjunto Minimo Básico de Datos), which is collected in hospitals and curated and published annually by the Ministry of Health. This clinical and administrative database, to which all Spanish hospitals are required to submit validated, and reliable data [12,13], has previously been utilized as a research tool in inguinal hernias [2,14] and other diseases [15]. Such types of databases have also been used in large inguinal hernia series in the US, Germany, and other countries [16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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Outpatient inguinal hernia repair in Spain: a population-based study of 1,163,039 patients—clinical and socioeconomic factors associated with the choice of day surgery

et al. 2022

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Reducing inpatient admissions and health care costs is a central aspiration of worldwide health systems. This study aimed to evaluate trends in outpatient surgery in inguinal hernia repair (IHR) and factors related to the outpatient setting in Spain. A retrospective cohort study (Record-Strobe compliant) of 1,163,039 patients who underwent IHR from January 2004 to December 2019 was conducted. Data were extracted from the public clinical administrative database CMBD (“Conjunto Mínimo Básico de Datos”). The primary outcome was the outpatient surgery rate. Univariate and multivariable analyses were performed to identify clinical and socioeconomic factors related to the outpatient setting. The overall proportion of outpatient repairs was 30.7% in 2004 and 54.2% in 2019 (p < 0.001). Treatment in a public hospital was the most remarkable factor associated with the likelihood of receiving an outpatient procedure (OR 3.408; p < 0.001). There were also significant differences favouring outpatient procedures for patients with public insurance (OR 2.351; p < 0.001), unilateral hernia (OR 2.903; p < 0.001), primary hernia (OR 1.937; p < 0.0005), age < 65 years (OR 1.747; p < 0.001) and open surgery (OR 1.610; p < 0.001). Only 9% of patients who pay for their intervention privately or 15% of those covered by private insurance were treated as outpatients. Spain has significantly increased the rate of outpatient IHR over the last 16 years. However, the figures obtained still leave a significant margin for improvement. Important questions about the acceptance of outpatient settings remain to be answered. Graphical Abstract Outpatient inguinal hernia repair in Spain. A population-based study of 1,163,039 patients: clinical and socioeconomic factors associated with the choice of day surgery.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Outpatient inguinal hernia repair in Spain: a population-based study of 1,163,039 patients—clinical and socioeconomic factors associated with the choice of day surgery

et al. 2022

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“…In the period 2016–1018, the global rate of LR for inguinal hernia in Spain was 5.7%, reaching 17.9% for bilateral hernia; only in one of the 51 provinces of the country was the rate of LR for bilateral hernia over 50% [ 13 ]. In our study, the choice of LR for bilateral hernia increased from 9.1% in 2017 to 90.9% in 2020.…”

Section: Discussionmentioning

confidence: 99%

“…The current international guidelines recommend a laparoscopic approach for bilateral groin hernia repair if surgical expertise and resources are available [, , , , 7 , 9 , 10 , 11 , 12 ]. However, the adoption of the laparoscopic approach has been reported to be very low in Spain (5.7%) [ 13 ], and in other countries such as the USA, it reaches 37.8% [ 14 ]. The learning curve and cost are the main limitations for choosing laparoscopy for inguinal hernia repair [, , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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The transition from open to laparoscopic surgery for bilateral inguinal hernia repair: how we did it

Hidalgo

Bachero

Hoyuela

et al. 2022

Langenbecks Arch Surg

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Purpose To describe the transition process from open repair (OR) to laparoscopic repair (LR) of bilateral inguinal hernia in a small basic general hospital Methods We describe the technical details and training strategy used to facilitate the transition to systematic LR of bilateral inguinal hernia. We conducted a retrospective analysis of prospectively collected data from all patients undergoing bilateral inguinal hernia repair between January 2017 and December 2020. We analysed the evolution of LR and compared the surgical outcomes: complications, acute pain (24 h), chronic pain (> 3 months), and recurrence (1 year) of the patients operated on by OR and LR. Results We performed 132 bilateral inguinal hernia repairs, 55 (41.7%) ORs, and 77 (58.3%) LRs. A significant difference was observed in the choice of LR over time (2017: 9%, 2018: 32%, 2019: 75%, 2020: 91%, p < 0.001). The mean operative time was shorter in the OR group than in the LR group (56 min vs. 108 min, p < 0.001). However, the operative time of the LR decreased over the years. No significant differences were observed in complications or recurrence. LR was associated with lower acute postoperative pain at 24 h (2.2 vs. 3.1 points, p = 0.021) and lower chronic groin pain than OR (1.3% vs. 12.7%, p = 0.009). Conclusion A structured and systematized training process made the transition from OR to LR of bilateral inguinal hernias feasible and safe in a small basic general hospital. This transition did not increase complications or recurrence. Additionally, LR was associated with a decrease in postoperative pain and chronic groin pain.

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Outpatient Surgery and Unplanned Overnight Admission in Bilateral Inguinal Hernia Repair: A Population-based Study

Hidalgo,

Guillaumes,

Llompart-Coll

et al. 2024

Langenbecks Arch Surg

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Purpose The use of outpatient surgery in inguinal hernia is heterogeneous despite clinical recommendations. This study aimed to analyze the utilization trend of outpatient surgery for bilateral inguinal hernia repair (BHIR) in Spain and identify the factors associated with outpatient surgery choice and unplanned overnight admission. Methods A retrospective observational study of patients undergoing BIHR from 2016 to 2021 was conducted. The clinical-administrative database of the Spanish Ministry of Health RAE-CMBD was used. Patient characteristics undergoing outpatient and inpatient surgery were compared. A multivariable logistic regression analysis was performed to identify factors associated with outpatient surgery choice and unplanned overnight admission. Results A total of 30,940 RHIBs were performed; 63% were inpatient surgery, and 37% were outpatient surgery. The rate of outpatient surgery increased from 30% in 2016 to 41% in 2021 (p < 0.001). Higher rates of outpatient surgery were observed across hospitals with a higher number of cases per year (p < 0.001). Factors associated with outpatient surgery choice were: age under 65 years (OR: 2.01, 95% CI: 1.92–2.11), hospital volume (OR: 1.59, 95% CI: 1.47–1.72), primary hernia (OR: 1.89, 95% CI: 1.71–2.08), and laparoscopic surgery (OR: 1.47, 95% CI: 1.39–1.56). Comorbidities were negatively associated with outpatient surgery. Open surgery was associated (OR: 1.26, 95% CI: 1.09–1.47) with unplanned overnight admission. Conclusions Outpatient surgery for BHIR has increased in recent years but is still low. Older age and comorbidities were associated with lower rates of outpatient surgery. However, the laparoscopic repair was associated with increased outpatient surgery and lower unplanned overnight admission.

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Inguinal hernia repair in Spain. A population-based study of 263,283 patients: factors associated with the choice of laparoscopic approach

Cited by 18 publications

References 40 publications

Outpatient inguinal hernia repair in Spain: a population-based study of 1,163,039 patients—clinical and socioeconomic factors associated with the choice of day surgery

Outpatient inguinal hernia repair in Spain: a population-based study of 1,163,039 patients—clinical and socioeconomic factors associated with the choice of day surgery

The transition from open to laparoscopic surgery for bilateral inguinal hernia repair: how we did it

Outpatient Surgery and Unplanned Overnight Admission in Bilateral Inguinal Hernia Repair: A Population-based Study

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