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Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair

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Abstract

Background

Black patients and older adults are less likely to receive minimally invasive hernia repair. These differences by race and age may be influenced by surgeon-specific utilization rate of minimally invasive repair. In this study, we explored the association between race, age, and surgeon utilization of minimally invasive surgery (MIS) with the likelihood of receiving MIS inguinal hernia repair.

Methods

A retrospective cohort study was performed in patients undergoing elective primary inguinal hernia repair from 2012 to 2016, using data from the Michigan Surgical Quality Collaborative, a 72-hospital clinical registry. Surgeons were stratified by proportion of MIS performed. Using hierarchical logistic regression models, we investigated the association between receiving MIS repair and race, age, and surgeon MIS utilization rate.

Results

Out of 4667 patients, 1253 (27%) received MIS repair. Out of 190 surgeons, 81 (43%) performed only open repair. Controlling for surgeon MIS utilization, race was not associated with MIS receipt (OR 0.93, p = 0.775), but older patients were less likely to receive MIS repair (OR 0.41, p < 0.001).

Conclusions

Race differences were explained by surgeon MIS utilization, implicating access to MIS-performing surgeon as a mediator. Conversely, age disparity was independent of MIS utilization, even after adjusting for comorbidities, indicating some degree of provider bias against performing MIS repair in older patients. Interventions to address disparities should include systematic efforts to improve access, as well as provider and patient education for older adults.

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References

  1. Lassiter RL et al (2017) Racial disparities in the use of laparoscopic surgery to treat colonic diverticulitis are not fully explained by socioeconomics or disease complexity. Am J Surg 213(4):673–677

    Article  PubMed  Google Scholar 

  2. Alnasser M et al (2014) National disparities in laparoscopic colorectal procedures for colon cancer. Surg Endosc 28(1):49–57

    Article  PubMed  Google Scholar 

  3. Patel PR et al (2014) Disparities in utilization of laparoscopic hysterectomies: a nationwide analysis. J Minim Invasive Gynecol 21(2):223–227

    Article  PubMed  Google Scholar 

  4. Varela JE, Nguyen NT (2011) Disparities in access to basic laparoscopic surgery at US academic medical centers. Surg Endosc 25(4):1209–1214

    Article  PubMed  Google Scholar 

  5. Tucker JJ et al (2011) Laparoscopic cholecystectomy is safe but underused in the elderly. Am Surg 77(8):1014–1020

    PubMed  Google Scholar 

  6. Smink DS, Paquette IM, Finlayson SR (2009) Utilization of laparoscopic and open inguinal hernia repair: a population-based analysis. J Laparoendosc Adv Surg Tech A 19(6):745–748

    Article  PubMed  Google Scholar 

  7. Zendejas B et al (2012) Trends in the utilization of inguinal hernia repair techniques: a population-based study. Am J Surg 203(3):313–317

    Article  PubMed  PubMed Central  Google Scholar 

  8. Trevisonno M et al (2015) Current practices of laparoscopic inguinal hernia repair: a population-based analysis. Hernia 19(5):725–733

    Article  CAS  PubMed  Google Scholar 

  9. Vu JV et al (2019) Surgeon utilization of minimally invasive techniques for inguinal hernia repair: a population-based study. Surg Endosc 33(2):486–493

    Article  PubMed  Google Scholar 

  10. Ielpo B et al (2018) A prospective randomized study comparing laparoscopic transabdominal preperitoneal (TAPP) versus Lichtenstein repair for bilateral inguinal hernias. Am J Surg 216(1):78–83

    Article  PubMed  Google Scholar 

  11. Bignell M et al (2012) Prospective randomized trial of laparoscopic (transabdominal preperitoneal-TAPP) versus open (mesh) repair for bilateral and recurrent inguinal hernia: incidence of chronic groin pain and impact on quality of life: results of 10 year follow-up. Hernia 16(6):635–640

    Article  CAS  PubMed  Google Scholar 

  12. Bowling K et al (2017) Laparoscopic and open inguinal hernia repair: Patient reported outcomes in the elderly from a single centre—a prospective cohort study. Ann Med Surg 22:12–15

    Article  CAS  Google Scholar 

  13. Eker HH et al (2012) Randomized clinical trial of total extraperitoneal inguinal hernioplasty vs lichtenstein repair: a long-term follow-up study. Arch Surg 147(3):256–260

    Article  PubMed  Google Scholar 

  14. McCormack K et al. (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 2003(1):Cd001785

    PubMed Central  Google Scholar 

  15. Abbas AE et al (2012) Patient-perspective quality of life after laparoscopic and open hernia repair: a controlled randomized trial. Surg Endosc 26(9):2465–2470

    Article  PubMed  Google Scholar 

  16. Wang WJ et al (2013) Comparison of the effects of laparoscopic hernia repair and Liechtenstein tension-free hernia repair. J Laparoendosc Adv Surg Tech A 23(4):301–305

    Article  PubMed  Google Scholar 

  17. Westin L et al (2016) Less pain 1 year after total extra-peritoneal repair compared with Liechtenstein using local anesthesia: data from a randomized controlled clinical trial. Ann Surg 263(2):240–243

    Article  PubMed  Google Scholar 

  18. Hendren S et al (2013) Antibiotic choice is independently associated with risk of surgical site infection after colectomy: a population-based cohort study. Ann Surg 257(3):469–475

    Article  PubMed  Google Scholar 

  19. Waits SA et al (2014) Developing an argument for bundled interventions to reduce surgical site infection in colorectal surgery. Surgery 155(4):602–606

    Article  PubMed  Google Scholar 

  20. The Center for the Evaluative Clinical Sciences, D.M.S (1996) The Dartmouth atlas of health care. 3rd ed. Chicago. American Hospital Publishing, [1996] ©1996

    Google Scholar 

  21. Hall EC et al (2015) Racial/ethnic disparities in emergency general surgery: explained by hospital-level characteristics? Am J Surg 209(4):604–609

    Article  PubMed  Google Scholar 

  22. Patel JA et al (2015) Risk factors for urinary retention after laparoscopic inguinal hernia repairs. Surg Endosc 29(11):3140–3145

    Article  PubMed  Google Scholar 

  23. Hope WW et al (2013) Comparing laparoscopic and open inguinal hernia repair in octogenarians. Hernia 17(6):719–722

    Article  CAS  PubMed  Google Scholar 

  24. Vigneswaran Y et al (2015) Elderly and octogenarian cohort: Comparable outcomes with nonelderly cohort after open or laparoscopic inguinal hernia repairs. Surgery 158(4):1137–1144

    Article  PubMed  Google Scholar 

  25. Dallas KB et al (2013) Laparoscopic versus open inguinal hernia repair in octogenarians: a follow-up study. Geriatr Gerontol Int 13(2):329–333

    Article  PubMed  Google Scholar 

  26. Haider AH et al (2013) Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors. J Am Coll Surg 216(3):482–492.e12

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wang EH et al (2016) Disparities in treatment of patients with high-risk prostate cancer: results from a population-based cohort. Urology 95:88–94

    Article  PubMed  Google Scholar 

  28. Ziehr DR et al (2015) Income inequality and treatment of African American men with high-risk prostate cancer. Urol Oncol 33(1):18.e7-18.e13

    Article  PubMed  Google Scholar 

  29. Gupta S et al (2016) Utilization of surgical procedures and racial disparity in the treatment of urinary incontinence after prostatectomy. Neurourol Urodyn 35(6):733–737

    Article  PubMed  Google Scholar 

  30. Holman KH et al (2011) Racial disparities in the use of revascularization before leg amputation in medicare patients. J Vasc Surg 54(2):420-6, 426.e1

    Article  PubMed  PubMed Central  Google Scholar 

  31. Dimick J et al (2013) Black patients more likely than whites to undergo surgery at low-quality hospitals in segregated regions. Health Aff 32(6):1046–1053

    Article  Google Scholar 

  32. Regenbogen SE et al (2009) Do differences in hospital and surgeon quality explain racial disparities in lower-extremity vascular amputations? Ann Surg 250(3):424–431

    PubMed  Google Scholar 

  33. Beadles CA, Meagher AD, Charles AG (2015) Trends in emergent hernia repair in the United States. JAMA Surg 150(3):194–200

    Article  PubMed  Google Scholar 

  34. Hernández-Irizarry R et al (2012) Trends in emergent inguinal hernia surgery in Olmsted County, MN: a population-based study. Hernia 16(4):397–403

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Dr. Vu receives funding from the National Institutes of Health Ruth L. Kirschstein National Research Service Award (1F32DK115340-01A1). Dr. Telem receives funding for this work from the Agency for Healthcare Research and Quality (AHRQ) (K08HS025778).

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Authors and Affiliations

  1. Department of Surgery, University of Michigan, 2800 Plymouth Road, Building 16, 1st Floor, Ann Arbor, MI, 48109, USA

    Joceline V. Vu, Vidhya Gunaseelan, Justin B. Dimick, Michael J. Englesbe, Darrell A. Campbell Jr. & Dana A. Telem

  2. Center for Health Outcomes and Policy, Ann Arbor, MI, 48109, USA

    Joceline V. Vu, Justin B. Dimick & Dana A. Telem

  3. Michigan Surgical Quality Collaborative, Ann Arbor, MI, 48109, USA

    Vidhya Gunaseelan, Michael J. Englesbe & Darrell A. Campbell Jr.

Authors
  1. Joceline V. Vu
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  2. Vidhya Gunaseelan
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  3. Justin B. Dimick
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  4. Michael J. Englesbe
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  5. Darrell A. Campbell Jr.
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  6. Dana A. Telem
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Corresponding author

Correspondence to Joceline V. Vu.

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Disclosures

Dr. Telem receives consulting fees for Medtronic. Dr. Vu, Ms. Gunaseelan, Dr. Dimick, Dr. Englesbe, and Dr. Campbell have no conflicts of interest or financial ties to report.

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Vu, J.V., Gunaseelan, V., Dimick, J.B. et al. Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair. Surg Endosc 33, 4032–4037 (2019). https://doi.org/10.1007/s00464-019-06695-0

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  • DOI: https://doi.org/10.1007/s00464-019-06695-0

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