Watchful Waiting Versus Surgery of Mildly Symptomatic or Asymptomatic Inguinal Hernia in Men Aged 50 Years and Older

Goede, Barry de; Wijsmuller, A. R.; Ramshorst, Gabriëlle H. van; Kempen, Bob J. van; Hop, Wim C. J.; Klitsie, Pieter J.; Scheltinga, Marc R.; Haan, Jos de; Mastboom, W. J. B.; Harst, Erwin van der; Simons, M. P.; Kleinrensink, Gert Jan; Jeekel, J.; Lange, Johan F.

doi:10.1097/sla.0000000000002243

Cited by 67 publications

(63 citation statements)

References 19 publications

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“…Study findings, limitations, generalisability, and current knowledge 22 Summarise key study findings and describe how they support the conclusions reached. Discuss limitations and the generalisability of the findings and how the findings fit with current knowledge.…”

Section: Discussionmentioning

confidence: 81%

Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness

Egmond¹,

Rongen²,

Hedeman³

et al. 2018

Clinical Otolaryngology

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Objective The objective of this study was to demonstrate how decision‐analytic modelling can help to determine circumstances under which surgery may become cost‐effective, using septoplasty as an example. Design We developed a decision‐analytic model comparing septoplasty to non‐surgical management for nasal obstruction in adults with a deviated septum. Based on the estimated cost difference between both treatments, we calculated the minimal (a) gain in quality‐adjusted life‐years, or (b) reduction in productivity losses needed for septoplasty to be cost‐effective. Input was derived from literature and publicly available data sources. The time horizon of our model was one year, and the willingness‐to‐pay per quality‐adjusted life‐year was €20 000, in accordance with current guidelines. Results The cost difference between septoplasty and non‐surgical management for nasal obstruction due to a deviated nasal septum was €2227 per patient from a healthcare perspective (including direct healthcare costs) and €3288 per patient from an extended perspective (additionally including travel expenses and productivity losses due to poor health). In comparison with non‐surgical management, septoplasty needed to gain 0.11 to 0.16 QALYs or save 13 sick days for nasal obstruction. The longer septoplasty's effect lasts, the more time it will have to compensate its extra costs. Conclusion This study shows that the known cost difference between treatments can be used as the starting point to determine beneficial effects needed for cost‐effectiveness of surgical interventions. The effect required by septoplasty from a healthcare perspective seems potentially achievable, meaning that it would be useful to perform an RCT assessing the actual benefits of septoplasty.

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Section: Discussionmentioning

confidence: 81%

Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness

Egmond¹,

Rongen²,

Hedeman³

et al. 2018

Clinical Otolaryngology

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“…In order to save medical resources and reduce the exposure of medical staff and patients, we could suspend the treatment of patients undergoing elective surgery as a special department for hernia and abdominal wall surgery. But for incarcerated hernia emergency patients, we could only choose active surgical intervention [11]. For such cases, NCP guidelines should be done in accordance with the protection requirements of hospital and isolation to avoid hospital infection.…”

Section: Discussionmentioning

confidence: 99%

Analysis of operation procedure and effect for emergency surgery in general hospital during novel coronavirus pneumonia period

et al. 2020

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Background: Novel coronavirus pneumonia (NCP) outbreak in Wuhan, China in early 2020, resulted in over 80 thousand infections in China. At present, NCP has an explosive growth in the world. Surgeons could refuse selective operation during the outbreak, but they must face the emergency operation. We hope to avoid the spread of NCP while ensuring efficient treatment of emergency cases. Methods: The data of patients with incarcerated hernia admitted to Beijing Chaoyang Hospital during NCP epidemic were analyzed and compared with those in 2019. All cases were divided into NCP group and 2019 group. The operation data and inpatient protection process of emergency cases were analyzed. Result During the NCP epidemic, 17 cases with incarcerated hernia were treated in our department. A Total of 263 cases of the same disease were admitted in 2019. There was no significant difference in age, gender, BMI and hernia type between two groups. No significant difference was observed between the two groups in operation method and hospital stay. The waiting time for emergency operation of NCP group was significantly longer than that of 2019 group (P = 0.002). A buffer ward was set up by administrator of hospital during NCP outbreak. Hospitals were divided into "Red area, Yellow area and Green area" artificially, and strict screening consultation system was implemented. There was no case of SARS-nCoV-2 infection in medical staff. Conclusion: It was safe and effective to carry out emergency operation on the premise of screening, protection and isolation during the NCP epidemic. The increased waiting time for operation due to NCP screening did not threaten medical safety of emergency incarcerated hernia patients.

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“…In contrast, only in men it is safely managed with nonoperative management (watchful waiting), as risk of emergency surgery is very low (2%) without any increased complications or mortality. However, majority of patients (over 70%) ultimately need surgical intervention most often due to pain, suggesting that watchful waiting is safe but only delays the inevitable surgery (Fitzgibbons and Forse 2015;De Goede et al 2018).…”

Section: Herniamentioning

confidence: 99%

Surgical Abdomen

Peláez¹,

Agarwal²

2020

Geriatric Gastroenterology

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Abdominal pain is a common and challenging problem in the geriatric population, characterized by severe pain that requires an urgent and specific diagnosis. A rapidly worsening prognosis is possible in absence of prompt intervention. The most common causes of acute abdomen in the older age group are acute cholecystitis, acute appendicitis, perforated peptic ulcer disease, acute pancreatitis, intestinal obstruction, ischemic bowel disease, diverticulitis, obstructed hernias and aortic aneurysm rupture. Symptoms and physical findings often

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Watchful Waiting Versus Surgery of Mildly Symptomatic or Asymptomatic Inguinal Hernia in Men Aged 50 Years and Older

Cited by 67 publications

References 19 publications

Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness

Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness

Analysis of operation procedure and effect for emergency surgery in general hospital during novel coronavirus pneumonia period

Surgical Abdomen

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