S Koebe1, J Greenberg2, L-C Huang3, S Phillips3, A Lidor2, L Funk2, A Shada4,5. 1. University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA. 2. Department of Surgery, University of Wisconsin, 600 Highland Ave, Madison, WI, 53736, USA. 3. America Hernia Society Quality Collaborative, Vanderbilt University Medical Center, Nashville, TN, USA. 4. Department of Surgery, University of Wisconsin, 600 Highland Ave, Madison, WI, 53736, USA. shada@surgery.wisc.edu. 5. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 4602 Eastpark Blvd Suite 3525, Madison, WI, 53718, USA. shada@surgery.wisc.edu.
Abstract
PURPOSE: The approach to repairing an initial umbilical hernia (IUH) varies substantially, and this likely depends on hernia size, patient age, sex, BMI, comorbidities including diabetes mellitus, and surgeon preference. Of these, only hernia size has been widely studied. This cross-sectional study aims to look at the practice pattern of umbilical hernia repair in the United States. METHODS: A retrospective study was performed using data from the America Hernia Society Quality Collaborative. Patient characteristics included age, sex, hernia width, BMI, smoking status, and diabetes. Outcomes were use of mesh for repair, as well as surgical approach (open vs minimally invasive). Multivariate logistic regression was performed to assess the independent effect of age, sex, hernia width, BMI, smoking status, and diabetes on use of mesh and approach to repair. RESULTS: 3475 patients were included. 74% were men. Mesh use was more common in men (67% vs 60%, P < 0.001). Mesh was used in 33% of repairs ≤ 1 cm, and 82% of repairs > 1 cm (P < 0.001). Younger patients were less likely to receive a mesh repair (54% if age ≤ 35 vs 67% for age > 35, P < 0.001). However, on multivariate analysis, mesh use was associated with increasing hernia width (OR 5.474, 95% CI 4.7-6.3) as well as BMI (OR 1.8, 95% CI 1.5-2.1) but not with age or sex. CONCLUSION: The majority of IUH are performed open. Patient BMI and hernia defect size contribute to choice of surgical technique including use of mesh. The use of mesh in 33% of hernias below 1 cm demonstrates a gap between evidence and practice. Patient factors including patient age and sex had no impact on operative approach or use of mesh.
PURPOSE: The approach to repairing an initial umbilical hernia (IUH) varies substantially, and this likely depends on hernia size, patient age, sex, BMI, comorbidities including diabetes mellitus, and surgeon preference. Of these, only hernia size has been widely studied. This cross-sectional study aims to look at the practice pattern of umbilical hernia repair in the United States. METHODS: A retrospective study was performed using data from the America Hernia Society Quality Collaborative. Patient characteristics included age, sex, hernia width, BMI, smoking status, and diabetes. Outcomes were use of mesh for repair, as well as surgical approach (open vs minimally invasive). Multivariate logistic regression was performed to assess the independent effect of age, sex, hernia width, BMI, smoking status, and diabetes on use of mesh and approach to repair. RESULTS: 3475 patients were included. 74% were men. Mesh use was more common in men (67% vs 60%, P < 0.001). Mesh was used in 33% of repairs ≤ 1 cm, and 82% of repairs > 1 cm (P < 0.001). Younger patients were less likely to receive a mesh repair (54% if age ≤ 35 vs 67% for age > 35, P < 0.001). However, on multivariate analysis, mesh use was associated with increasing hernia width (OR 5.474, 95% CI 4.7-6.3) as well as BMI (OR 1.8, 95% CI 1.5-2.1) but not with age or sex. CONCLUSION: The majority of IUH are performed open. Patient BMI and hernia defect size contribute to choice of surgical technique including use of mesh. The use of mesh in 33% of hernias below 1 cm demonstrates a gap between evidence and practice. Patient factors including patient age and sex had no impact on operative approach or use of mesh.
Authors: Mette W Christoffersen; Frederik Helgstrand; Jacob Rosenberg; Henrik Kehlet; Pernille Strandfelt; Thue Bisgaard Journal: Am J Surg Date: 2014-07-31 Impact factor: 2.565
Authors: Ruth Kaufmann; Jens A Halm; Hasan H Eker; Pieter J Klitsie; Jeroen Nieuwenhuizen; Dick van Geldere; Maarten P Simons; Erwin van der Harst; Martijne van 't Riet; Bronno van der Holt; Gert Jan Kleinrensink; Johannes Jeekel; Johan F Lange Journal: Lancet Date: 2018-02-17 Impact factor: 79.321
Authors: F Köckerling; W Brunner; R Fortelny; F Mayer; D Adolf; H Niebuhr; R Lorenz; W Reinpold; K Zarras; D Weyhe Journal: Hernia Date: 2020-11-25 Impact factor: 4.739
Authors: F Köckerling; W Brunner; F Mayer; R Fortelny; D Adolf; H Niebuhr; R Lorenz; W Reinpold; K Zarras; D Weyhe Journal: Hernia Date: 2020-09-20 Impact factor: 4.739