Substantial variation among hernia experts in the decision for treatment of patients with incisional hernia: a descriptive study on agreement
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Substantial variation among hernia experts in the decision for treatment of patients with incisional hernia : a descriptive study on agreement. / Kokotovic, D; Gögenur, I; Helgstrand, F.
I: Hernia, Bind 21, Nr. 2, 2017, s. 271-278.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Substantial variation among hernia experts in the decision for treatment of patients with incisional hernia
T2 - a descriptive study on agreement
AU - Kokotovic, D
AU - Gögenur, I
AU - Helgstrand, F
PY - 2017
Y1 - 2017
N2 - PURPOSE: Benign elective procedures give rise to heterogeneity in indication for surgery and surgical technique among specialized surgeons in a variety of surgical fields. The objective was to analyze the extent of agreement in surgical management among expert hernia surgeons when evaluating the same patient in a standardized setting.METHODS: Five Danish hernia experts answered questions concerning indication for surgery and surgical technique for 25 video recorded real-life clinical cases. The experts evaluated the patients by answering a standardized questionnaire.RESULTS: All surgeons were experienced in incisional hernia repair with a median of 253 repairs (range 164-450 repairs). Perfect overall agreement among all the experts in indication, operation type, component separation, mesh fixation and mesh position was found in only five cases (20%). Agreement in indication for surgery was present in 14 cases (56%). The most common reason for not performing surgery was due to comorbidities. Agreement in operation type (open vs. laparoscopic) was present in 10 cases (40%). Agreement in mesh fixation (absorbable tacks/non-absorbable tacks/suture/other) method was also present in 10 cases (40%). Agreement in mesh position (onlay, sublay or intraperitoneal) was found in 40% of cases. The highest overall agreement among the surgeons was observed with regard to whether patients needed component separation (yes/no), 21 cases, (84%).CONCLUSIONS: In a standardized setting, agreement in choice of treatment strategy for patients with incisional hernias was very low among experienced surgeons. A standardization of surgical decision making is desirable to develop new interventions and improve clinical outcomes.
AB - PURPOSE: Benign elective procedures give rise to heterogeneity in indication for surgery and surgical technique among specialized surgeons in a variety of surgical fields. The objective was to analyze the extent of agreement in surgical management among expert hernia surgeons when evaluating the same patient in a standardized setting.METHODS: Five Danish hernia experts answered questions concerning indication for surgery and surgical technique for 25 video recorded real-life clinical cases. The experts evaluated the patients by answering a standardized questionnaire.RESULTS: All surgeons were experienced in incisional hernia repair with a median of 253 repairs (range 164-450 repairs). Perfect overall agreement among all the experts in indication, operation type, component separation, mesh fixation and mesh position was found in only five cases (20%). Agreement in indication for surgery was present in 14 cases (56%). The most common reason for not performing surgery was due to comorbidities. Agreement in operation type (open vs. laparoscopic) was present in 10 cases (40%). Agreement in mesh fixation (absorbable tacks/non-absorbable tacks/suture/other) method was also present in 10 cases (40%). Agreement in mesh position (onlay, sublay or intraperitoneal) was found in 40% of cases. The highest overall agreement among the surgeons was observed with regard to whether patients needed component separation (yes/no), 21 cases, (84%).CONCLUSIONS: In a standardized setting, agreement in choice of treatment strategy for patients with incisional hernias was very low among experienced surgeons. A standardization of surgical decision making is desirable to develop new interventions and improve clinical outcomes.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Comorbidity
KW - Contraindications
KW - Decision Making
KW - Elective Surgical Procedures
KW - Female
KW - Hernia, Ventral/surgery
KW - Herniorrhaphy/methods
KW - Humans
KW - Incisional Hernia/surgery
KW - Laparoscopy
KW - Male
KW - Middle Aged
KW - Recurrence
KW - Surgical Mesh
KW - Surveys and Questionnaires
U2 - 10.1007/s10029-016-1562-y
DO - 10.1007/s10029-016-1562-y
M3 - Journal article
C2 - 27915385
VL - 21
SP - 271
EP - 278
JO - Hernia : the journal of hernias and abdominal wall surgery
JF - Hernia : the journal of hernias and abdominal wall surgery
SN - 1265-4906
IS - 2
ER -
ID: 195513163