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Unnecessary use of radiology studies in the diagnosis of inguinal hernias: a retrospective cohort study

Abstract

Background

The diagnosis of inguinal hernias is predominantly based on physical exam, although imaging may be used in select cases. The objective of this study was to determine the frequency of unnecessary imaging used in the diagnosis of inguinal hernias.

Methods

Patients who underwent elective inguinal hernia repair at a large academic health system in the U.S. from 2010 to 2017 were included. Within this cohort, we identified patients who received imaging 6 months prior to surgery. Through chart review of physical exam findings and imaging indications, we categorized patients into four imaging categories: unrelated, necessary, unnecessary, and borderline. Multivariable logistic regression analysis was used to identify factors associated with receipt of unnecessary imaging.

Results

Of 2162 patients who underwent inguinal hernia surgery, 249 patients had related imaging studies 6 months prior to surgery. 47.0% of patients received unnecessary imaging. 66.9% and 33.1% of unnecessary studies were ultrasounds and CT scans, respectively. 24.5% of patients had necessary studies, while 28.5% had studies with borderline indications. On multivariable analysis, having a BMI between 25.0 and 29.9 kg/m2 was associated with receipt of unnecessary studies. Primary care providers and ED physicians were more likely to order unnecessary imaging.

Conclusions

Nearly 50% of all patients who receive any related imaging prior to surgery had potentially unnecessary diagnostic radiology studies. This not only exposes patients to avoidable risks, but also places a significant economic burden on patients and our already-strained health system.

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Funding

This work was supported in part by the NIH T32 Surgical Oncology Research Training Program (Grant T32 CA090217-17). This content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. Effort on this study was also made possible by a VA Career Development Award to Dr. Funk (5103). The views represented in this study represent those of the authors and not those of the Department of Veterans Affairs or the U.S. Government.

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Authors

Contributions

All co-authors contributed to study design. YX, NL, and AOL contributed to data analysis. NL, TMP, YX, and AOL contributed to manuscript composition. All co-authors contributed in the data interpretation and manuscript revisions. All co-authors approved the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.

Corresponding author

Correspondence to Anne O. Lidor.

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Disclosures

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf. Dr. Natalie Liu, Dr. Tyler M. Prout, Ms. Yiwei Xu, Dr. Jeremy Smith, Dr. Luke M. Funk, Dr. Jacob A. Greenberg, Dr. Amber L. Shada, and Dr. Anne O. Lidor have no conflicts of interest or financial ties to disclose.

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Liu, N., Prout, T.M., Xu, Y. et al. Unnecessary use of radiology studies in the diagnosis of inguinal hernias: a retrospective cohort study. Surg Endosc 35, 4444–4451 (2021). https://doi.org/10.1007/s00464-020-07947-0

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  • DOI: https://doi.org/10.1007/s00464-020-07947-0

Keywords

  • Hernia
  • inguinal
  • Radiology
  • General surgery
  • Outcome assessment
  • Health services research