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

  • Joceline V. VuEmail author
  • Vidhya Gunaseelan
  • Justin B. Dimick
  • Michael J. Englesbe
  • Darrell A. CampbellJr.
  • Dana A. Telem
Article

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.

Keywords

Inguinal hernia repair Laparoscopy Surgical technology Robotic inguinal hernia repair Minimally invasive surgery Surgical disparity 

Notes

Financial support

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).

Compliance with Ethical Standards

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.

References

  1. 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):673–677Google Scholar
  2. 2.
    Alnasser M et al (2014) National disparities in laparoscopic colorectal procedures for colon cancer. Surg Endosc 28(1):49–57Google Scholar
  3. 3.
    Patel PR et al (2014) Disparities in utilization of laparoscopic hysterectomies: a nationwide analysis. J Minim Invasive Gynecol 21(2):223–227Google Scholar
  4. 4.
    Varela JE, Nguyen NT (2011) Disparities in access to basic laparoscopic surgery at US academic medical centers. Surg Endosc 25(4):1209–1214Google Scholar
  5. 5.
    Tucker JJ et al (2011) Laparoscopic cholecystectomy is safe but underused in the elderly. Am Surg 77(8):1014–1020Google Scholar
  6. 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):745–748Google Scholar
  7. 7.
    Zendejas B et al (2012) Trends in the utilization of inguinal hernia repair techniques: a population-based study. Am J Surg 203(3):313–317Google Scholar
  8. 8.
    Trevisonno M et al (2015) Current practices of laparoscopic inguinal hernia repair: a population-based analysis. Hernia 19(5):725–733Google Scholar
  9. 9.
    Vu JV et al (2019) Surgeon utilization of minimally invasive techniques for inguinal hernia repair: a population-based study. Surg Endosc 33(2):486–493Google Scholar
  10. 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):78–83Google Scholar
  11. 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):635–640Google Scholar
  12. 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 22:12–15Google Scholar
  13. 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):256–260Google Scholar
  14. 14.
    McCormack K et al. (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 2003(1):Cd001785Google Scholar
  15. 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):2465–2470Google Scholar
  16. 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):301–305Google Scholar
  17. 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):240–243Google Scholar
  18. 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):469–475Google Scholar
  19. 19.
    Waits SA et al (2014) Developing an argument for bundled interventions to reduce surgical site infection in colorectal surgery. Surgery 155(4):602–606Google Scholar
  20. 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] ©1996Google Scholar
  21. 21.
    Hall EC et al (2015) Racial/ethnic disparities in emergency general surgery: explained by hospital-level characteristics? Am J Surg 209(4):604–609Google Scholar
  22. 22.
    Patel JA et al (2015) Risk factors for urinary retention after laparoscopic inguinal hernia repairs. Surg Endosc 29(11):3140–3145Google Scholar
  23. 23.
    Hope WW et al (2013) Comparing laparoscopic and open inguinal hernia repair in octogenarians. Hernia 17(6):719–722Google Scholar
  24. 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):1137–1144Google Scholar
  25. 25.
    Dallas KB et al (2013) Laparoscopic versus open inguinal hernia repair in octogenarians: a follow-up study. Geriatr Gerontol Int 13(2):329–333Google Scholar
  26. 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.e12Google Scholar
  27. 27.
    Wang EH et al (2016) Disparities in treatment of patients with high-risk prostate cancer: results from a population-based cohort. Urology 95:88–94Google Scholar
  28. 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.e13Google Scholar
  29. 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):733–737Google Scholar
  30. 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.e1Google Scholar
  31. 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):1046–1053Google Scholar
  32. 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):424–431Google Scholar
  33. 33.
    Beadles CA, Meagher AD, Charles AG (2015) Trends in emergent hernia repair in the United States. JAMA Surg 150(3):194–200Google Scholar
  34. 34.
    Hernández-Irizarry R et al (2012) Trends in emergent inguinal hernia surgery in Olmsted County, MN: a population-based study. Hernia 16(4):397–403Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of MichiganAnn ArborUSA
  2. 2.Center for Health Outcomes and PolicyAnn ArborUSA
  3. 3.Michigan Surgical Quality CollaborativeAnn ArborUSA

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