Long‐Term Trends and Predictors of Medical Resource Utilization and Medical Outcomes in Inguinal Hernia Repair: A Nationwide Cohort Study

Abstract

Background Few studies have comprehensively and systematically analyzed nationwide samples. This study purposed to explore temporal trends and predictors of medical resource utilization and medical outcomes in these patients to obtain data that can be used to improve healthcare policies and to support clinical and administrative decision‐making. Methods This study used nationwide population data contained in the Longitudinal Health Insurance Database of Taiwan. The 14,970 inguinal hernia repair patients were enrolled in this study (age range, 18–100 years) from 1997 to 2013 in Taiwan. After temporal trends analysis of demographic characteristics, clinical characteristics, and institutional characteristics, predictors of postoperative medical resource utilization and medical outcomes were evaluated through multiple linear regression analysis and Cox regression analysis. Results The prevalence of inguinal hernia repair per 100,000 population significantly decreased from 195.38 in 1997 to 39.66 in 2013 (p < 0.05). Demographic characteristics, clinical characteristics, and institutional characteristics were significantly associated with postoperative medical resource utilization and medical outcomes (p < 0.05). Of these characteristics, both surgeon volume and hospital volume had the strongest association. Conclusions The inguinal hernia repair prevalence rate gradually decreased during the study period. Demographic characteristics, clinical characteristics, and institutional characteristics had strong associations with postoperative medical resource utilization and medical outcomes. Furthermore, hospital volume and surgeon volume had the strongest associations with postoperative medical resource utilization and medical outcomes. Additionally, providing the education needed to make the most advantageous medical decisions would be a great service not only to patients and their families, but also to the general population.

Cost and Effectiveness of Long-Term Care Following Integrated Discharge Planning: A Prospective Cohort Study

“…The unit of statistical analysis in this Taiwanese study was the individual elderly patient [26,27]. Sample size calculations determined that, for a power of 0.80, a minimum sample of 120 study participants was needed with an alpha of 0.05 [28].…”

Pre-operative factors associated with short- and long-term outcomes in the patient with inguinal hernia: What does the current evidence say?

“…In the review of the literature on the relationship between pre-operative symptomatology and post-operative outcomes, it was observed that the vast majority of studies have not researched a specific symptomatology, but include a heterogeneous group of signs and symptoms, contrasting them with divergent results [ [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] ]. Evaluating the level of evidence in descending order (from highest level to lowest level of available evidence) on pre-operative symptomatology and its relationship with outcomes, only one systematic review [ 11 ], one clinical trial [ 12 ] and a considerable number of observational studies were found [ [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ]. Reinpold W [ 11 ] conducted a systematic review where he evaluated risk factors for the development of chronic pain after inguinal hernia repair, showing that intense pre-operative pain, alteration in the patient's mood and history of chronic pain regardless of its cause, are associated with the onset and persistence of this chronic pain [ 11 ].…”

“…Romain et al [ 16 ], Mier et al [ 17 ] and Kuo et al [ 18 ], conducted prospective studies with the aim of evaluating the long-term quality of life of patients with inguinal hernia, according to pre-operative symptomatology, finding similar results, on the prevalence of pre-operative pain (>25% of cases) vs. pain at two years (<5% of cases), and predominantly this pain was moderate [ [16] , [17] , [18] ]. Similarly, quality of life is restored more quickly in those who have no pain or very mild pain (p = 0.048) [ 17 ].…”

“…Similarly, quality of life is restored more quickly in those who have no pain or very mild pain (p = 0.048) [ 17 ]. Particularly, the study by Kuo et al [ 18 ] associated not only pain, but general clinical characteristics with the use of medical resources and global outcomes (p < 0.05) [ 18 ]. Thus, it can be seen that the main symptom evaluated as a predictor of functional outcome is pain, which has a similar behavior, without discriminating by the surgical technique used [ 19 ].…”

“…Thus, it can be seen that the main symptom evaluated as a predictor of functional outcome is pain, which has a similar behavior, without discriminating by the surgical technique used [ 19 ]. Although some studies mention other symptoms, they do not seem to be significant or relevant on global outcomes, nor on physical or emotional quality of life [ 18 ].…”