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Surgical trends of groin hernia repairs performed for recurrence in medicare patients

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Abstract

Background

The recurrence rate after groin hernia repair (GHR) has been estimated to be between 1–10% in adult patients. Neither national rates nor trends in recurrence over time have been reliably established for Medicare patients in the USA.

Materials

We evaluated patients undergoing GHR (inguinal = IHR; femoral = FHR) from 2011 to 2014 from the Medicare Provider Analysis and Review database. Patients were identified using ICD-9 diagnosis and ICD-9 and CPT procedure codes, stratified both by primary vs. recurrent hernia repair and by sex. One-tailed Cochran–Armitage tests evaluated trends over time and a generalized estimating equation model estimated factors associated with recurrent IHR or FHR.

Results

We identified 407,717 patients (87.0%, ≥ 65 years) who underwent an IHR and 11,578 (91.0%, ≥ 65 years) who underwent a FHR. The proportion of IHRs for recurrence decreased statistically from 14.3% in 2011 to 13.9% in 2014 (p < 0.01) in males and was increased, but not statistically so (7.0–7.4%) in females (p = 0.08). The proportion of FHRs for recurrence was decreased, but not statistically so (16.3–14.8%, p = 0.29) in males and increased in females (5.3–6.3%, p = 0.02). On multivariable analysis, males were more than twice as likely as females to undergo recurrent repair (IHR or FHR, both p < 0.01).

Conclusions

Within the Medicare population, recurrence rates after groin hernia repairs were found to be higher than previously reported but have remained clinically stable over time. Establishing and reducing this rate is important for patient outcomes and expectations.

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References

  1. Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin N Am 83(5):1045–1051, v-vi

    Article  Google Scholar 

  2. Bittner R, Sauerland S, Schmedt CG (2005) Comparison of endoscopic techniques vs Shouldice and other open nonmesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19(5):605–615

    Article  CAS  PubMed  Google Scholar 

  3. Burcharth J (2014) The epidemiology and risk factors for recurrence after inguinal hernia surgery. Dan Med J 61(5):B4846

    PubMed  Google Scholar 

  4. Andresen K, Friis-Andersen H, Rosenberg J (2016) Laparoscopic repair of primary inguinal hernia performed in public hospitals or low-volume centers have increased risk of reoperation for recurrence. Surg Innov 23(2):142–147

    Article  Google Scholar 

  5. Bendavid R (1989) Femoral hernias: primary versus recurrence. Int Surg 74(2):99–100

    CAS  PubMed  Google Scholar 

  6. Burcharth J, Andresen K, Pommergaard HC, Bisgaard T, Rosenberg J (2014) Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences. Langenbeck’s Arch Surg 399(1):71–76

    Article  Google Scholar 

  7. Haapaniemi S, Nilsson E (2002) Recurrence and pain three years after groin hernia repair. Validation of postal questionnaire and selective physical examination as a method of follow-up. Eur J Surg 168(1):22–28

    Article  Google Scholar 

  8. Nilsson E, Kald A, Anderberg B, Bragmark M, Fordell R, Haapaniemi S, Heuman R, Lindhagen J, Stubberod A, Wickbom J (1997) Hernia surgery in a defined population: a prospective three year audit. Eur J Surg 163(11):823–829

    CAS  PubMed  Google Scholar 

  9. Center for Medicare and Medicaid Services, Medicare Program—general information (2017). https://www.cms.gov/Medicare/Medicare-General-Information/MedicareGenInfo/index.html. Accessed 7 Aug 2017

  10. Nilsson E, Haapaniemi S, Gruber G, Sandblom G (1998) Methods of repair and risk for reoperation in Swedish hernia surgery from 1992 to 1996. Br J Surg 85(12):1686–1691

    Article  CAS  PubMed  Google Scholar 

  11. Cox TC, Huntington CR, Blair LJ, Prasad T, Heniford BT, Augenstein VA (2017) Quality of life and outcomes for femoral hernia repair: does laparoscopy have an advantage? Hernia 21(1):79–88

    Article  CAS  PubMed  Google Scholar 

  12. Amid PK (2004) Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia 8(1):1–7

    Article  PubMed  Google Scholar 

  13. Huerta S, Patel PM, Mokdad AA, Chang J (2016) Predictors of inguinodynia, recurrence, and metachronous hernias after inguinal herniorrhaphy in veteran patients. Am J Surg 212(3):391–398

    Article  PubMed  Google Scholar 

  14. Neumayer LA, Gawande AA, Wang J, Giobbie-Hurder A, Itani KM, Fitzgibbons RJ Jr, Reda D, Jonasson O (2005) Proficiency of surgeons in inguinal hernia repair: effect of experience and age. Ann Surg 242(3):344–348 (discussion 348–352)

    PubMed  PubMed Central  Google Scholar 

  15. Ramshaw B, Abiad F, Voeller G, Wilson R, Mason E (2003) Polyester (Parietex) mesh for total extraperitoneal laparoscopic inguinal hernia repair: initial experience in the United States. Surg Endosc 17(3):498–501

    Article  CAS  PubMed  Google Scholar 

  16. Thompson JS, Gibbs JO, Reda DJ, McCarthy M Jr, Wei Y, Giobbie-Hurder A, Fitzgibbons RJ Jr (2008) Does delaying repair of an asymptomatic hernia have a penalty? Am J Surg 195(1):89–93

    Article  PubMed  Google Scholar 

  17. Zendejas B, Onkendi EO, Brahmbhatt RD, Lohse CM, Greenlee SM, Farley DR (2011) Long-term outcomes of laparoscopic totally extraperitoneal inguinal hernia repairs performed by supervised surgical trainees, Am J Surg 201(3):379–383 (discussion 383–384)

    Article  PubMed  Google Scholar 

  18. Rogers FB, Guzman EA (2011) Inguinal hernia repair in a community setting: implications for the elderly. Hernia 15(1):37–42

    Article  CAS  PubMed  Google Scholar 

  19. Abi-Haidar Y, Sanchez V, Itani KM (2011) Risk factors and outcomes of acute versus elective groin hernia surgery. J Am Coll Surg 213(3):363–369

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  21. Nolsoe A, Andresen K, Rosenberg J (2016) Repair of recurrent hernia is often performed at a different clinic. Hernia 20(6):783–787

    Article  CAS  Google Scholar 

  22. Murphy BL, Ubl DS, Zhang J, Habermann EB, Farley D, Paley K (2018) Proportion of femoral hernia repairs performed for recurrence in the United States. Hernia 22(4):593–602

    Article  CAS  PubMed  Google Scholar 

  23. Burcharth J, Pommergaard HC, Bisgaard T, Rosenberg J (2015) Patient-related risk factors for recurrence after inguinal hernia repair: a systematic review and meta-analysis of observational studies. Surg Innov 22(3):303–317

    Article  Google Scholar 

  24. Andresen K, Bisgaard T, Kehlet H, Wara P, Rosenberg J (2014) Reoperation rates for laparoscopic vs open repair of femoral hernias in Denmark: a nationwide analysis. JAMA Surg 149(8):853–857

    Article  Google Scholar 

  25. El-Dhuwaib Y, Corless D, Emmett C, Deakin M, Slavin J (2013) Laparoscopic versus open repair of inguinal hernia: a longitudinal cohort study. Surg Endosc 27(3):936–945

    Article  PubMed  Google Scholar 

  26. Keller JJ, Muo CH, Lan YC, Sung FC, Lo FE, Chiang KY, Lyu SY, Tsai ST (2015) A nation-wide population-based study of inguinal hernia repair incidence and age-stratified recurrence in an Asian population. Hernia 19(5):735–740

    Article  CAS  PubMed  Google Scholar 

  27. Voorbrood CE, Burgmans JP, Clevers GJ, Davids PH, Verleisdonk EJ, van Dalen T (2015) Totally extraperitoneal (TEP) endoscopic hernia repair in elderly patients. Hernia 19(6):887–891

    Article  CAS  PubMed  Google Scholar 

  28. Wu JJ, Baldwin BC, Goldwater E, Counihan TC (2017) Should we perform elective inguinal hernia repair in the elderly? Hernia 21(1):51–57

    Article  CAS  Google Scholar 

  29. Vigneswaran Y, Gitelis M, Lapin B, Denham W, Linn J, Carbray J, Ujiki M (2015) Elderly and octogenarian cohort: comparable outcomes with nonelderly cohort after open or laparoscopic inguinal hernia repairs. Surgery 158(4):1137–1143 (discussion 1143–1144)

    Article  Google Scholar 

  30. Kald A, Nilsson E, Anderberg B, Bragmark M, Engstrom P, Gunnarsson U, Haapaniemi S, Lindhagen J, Nilsson P, Sandblom G, Stubberod A (1998) Reoperation as surrogate endpoint in hernia surgery. A three year follow-up of 1565 herniorrhaphies. Eur J Surg 164(1):45–50

    Article  CAS  Google Scholar 

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Acknowledgements

The authors would like to acknowledge and thank the Mayo Clinic Department of Surgery, the Kern Center for the Science of Health Care Delivery, and Medtronic as substantial contributors of resources to this project.

Funding

The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery provides salary support for Dr. Habermann, Dr. Murphy, and Mr. Ubl. Dr. Jianying Zhang is an employee of Medtronic and provided the analysis of the MedPAR Database. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic Rochester, 200 First Street Southwest, Rochester, MN, 55905, USA

    B. L. Murphy, E. B. Habermann, D. R. Farley & K. Paley

  2. The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program, Mayo Clinic Rochester, Rochester, MN, USA

    B. L. Murphy, D. S. Ubl & E. B. Habermann

  3. Medtronic, Mansfield, MA, USA

    J. Zhang

Authors
  1. B. L. Murphy
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  2. J. Zhang
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  3. D. S. Ubl
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  4. E. B. Habermann
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  5. D. R. Farley
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  6. K. Paley
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Corresponding author

Correspondence to K. Paley.

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Conflict of interest

The authors have no conflicts of interest to disclose. Dr. Zhang is an employee of Medtronic and completed the analysis of the MedPAR database. We teamed with Medtronic to help perform the statistical analyses of the MedPAR database due to their expertise in analyzing this extensive data source. Medtronic shared in our goals of identifying the current state of hernia repairs in the United States as a whole and offered to partner with us for this study. Dr. Zhang performed the statistical analysis of the MedPAR data, which was critically evaluated and discussed among all authors. All authors were involved in data interpretation. Our agreement with Medtronic precluded financial considerations for this project.

Ethical approval

This study was reviewed by the Mayo Clinic IRB and found to be exempt as it involved de-identified data from national databases and they determined that it does not constitute research involving human subjects as defined under 45 CFR 46.102.

Human and animal rights

This article does not contain any studies directly involving human participants, as it is a review of data already collected in a database.

Informed consent

For this type of study, formal consent was not necessary.

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Murphy, B.L., Zhang, J., Ubl, D.S. et al. Surgical trends of groin hernia repairs performed for recurrence in medicare patients. Hernia 23, 677–683 (2019). https://doi.org/10.1007/s10029-018-1852-7

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  • DOI: https://doi.org/10.1007/s10029-018-1852-7

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