Abstract：
BACKGROUND: Many complex abdominal hernias are referred to tertiary academic institutions for evaluation and treatment. The purpose of this study was to compare clinical outcomes from complex abdominal hernia repairs and abdominal wall reconstructions at a community hospital vs high volume academic centers participating in Abdominal Core Health Quality Collaborative (ACHQC).
METHODS: Patients undergoing elective complex abdominal hernia repair were identified in our community setting and treated between 2016 and 2019. These results were then compared to Academic centers in the ACHQC database. Complex hernia definition was limited to those who have undergone any myofascial advancement procedure for homogeneity. Informed consent was obtained, and study was IRB approved. All data was de-identified.
RESULTS: A total of 180 patients underwent complex abdominal hernia repair at our community hospital. The ACHQC database identified 6299 patients meeting criteria at participating academic centers. Demographics were similar between the two groups including hernia grade, size and wound class. Academic centers tended to have patients with previous component separations (25.7% vs 10.6%) and immunosuppressed (7.2% vs 2.8%), while the community hospital patients included more patients with tobacco use (18.9% vs 12.1%) and hypertension (65% vs 54.9%). Operative times were significantly less at the community hospital, patients requiring >240 minutes of time for repair at academic centers (39.6% vs 5%). Postoperatively length of stay was significantly shorter at the community hospital group averaging 3.7 days vs academic centers of 6 days (P < .05). Although overall complications were less in the community hospital group (26.5% vs 19.4%). Readmission within 30 days was nearly twice as frequent in the community hospital group (14.4% vs 7.7%).
CONCLUSIONS: Community hospitals can provide comparable care and surgical expertise as major academic centers in regard to complex hernias in a large majority of cases. There is a need for dedicated care coordination and continuous review of supporting staff and outcomes is necessary to assure quality care. There is still a need to identify which patients would benefit from treatment at an academic center as opposed to a community hospital in order to maximize patient access and outcomes at both types of hospital setting. Further investigation needs to be performed regarding criteria for which patients should be transferred to academic centers for their complex hernia care. Identifying patients who would benefit from treatment at Academic Centers as opposed to Community hospitals should continue to be investigated.
METHODS: Patients undergoing elective complex abdominal hernia repair were identified in our community setting and treated between 2016 and 2019. These results were then compared to Academic centers in the ACHQC database. Complex hernia definition was limited to those who have undergone any myofascial advancement procedure for homogeneity. Informed consent was obtained, and study was IRB approved. All data was de-identified.
RESULTS: A total of 180 patients underwent complex abdominal hernia repair at our community hospital. The ACHQC database identified 6299 patients meeting criteria at participating academic centers. Demographics were similar between the two groups including hernia grade, size and wound class. Academic centers tended to have patients with previous component separations (25.7% vs 10.6%) and immunosuppressed (7.2% vs 2.8%), while the community hospital patients included more patients with tobacco use (18.9% vs 12.1%) and hypertension (65% vs 54.9%). Operative times were significantly less at the community hospital, patients requiring >240 minutes of time for repair at academic centers (39.6% vs 5%). Postoperatively length of stay was significantly shorter at the community hospital group averaging 3.7 days vs academic centers of 6 days (P < .05). Although overall complications were less in the community hospital group (26.5% vs 19.4%). Readmission within 30 days was nearly twice as frequent in the community hospital group (14.4% vs 7.7%).
CONCLUSIONS: Community hospitals can provide comparable care and surgical expertise as major academic centers in regard to complex hernias in a large majority of cases. There is a need for dedicated care coordination and continuous review of supporting staff and outcomes is necessary to assure quality care. There is still a need to identify which patients would benefit from treatment at an academic center as opposed to a community hospital in order to maximize patient access and outcomes at both types of hospital setting. Further investigation needs to be performed regarding criteria for which patients should be transferred to academic centers for their complex hernia care. Identifying patients who would benefit from treatment at Academic Centers as opposed to Community hospitals should continue to be investigated.
摘要：
背景：许多复杂的腹部疝被称为三级学术机构进行评估和治疗。这项研究的目的是比较社区医院与参加腹部核心健康质量协作（ACHQC）的高容量学术中心的复杂腹部疝修补和腹壁重建的临床结果。
方法：在我们的社区环境中确定了接受选择性复杂腹部疝修补术的患者，并于2016年至2019年进行了治疗。然后将这些结果与ACHQC数据库中的学术中心进行比较。复杂疝的定义仅限于那些经历过任何肌筋膜前移手术的人。获得知情同意，研究获得IRB批准。所有数据都被去识别。
结果：共有180例患者在我们社区医院接受了复杂的腹部疝修补术。ACHQC数据库确定了参与学术中心符合标准的6299名患者。两组的人口统计学特征相似，包括疝气分级，大小和伤口等级。学术中心倾向于有先前成分分离（25.7％对10.6％）和免疫抑制（7.2％对2.8％）的患者，而社区医院患者包括更多的吸烟患者(18.9%vs12.1%)和高血压患者(65%vs54.9%)。社区医院的手术时间明显减少，在学术中心需要>240分钟修复时间的患者(39.6%vs5%)。社区医院组术后平均住院时间为3.7天，而学术中心为6天（P<0.05）。尽管社区医院组的总体并发症较少（26.5％vs19.4％）。在社区医院组中，30天内再次入院的频率几乎是社区医院组的两倍（14.4％vs7.7％）。
结论：在大多数病例中，社区医院可以提供与主要学术中心相当的护理和外科专业知识。有必要进行专门的护理协调，并对支持人员进行持续审查，以确保高质量的护理。仍然需要确定哪些患者将从学术中心而不是社区医院的治疗中受益，以便在两种类型的医院环境中最大化患者的访问和结果。需要对患者应转移到学术中心进行复杂的疝气护理的标准进行进一步的调查。应继续调查确定将从学术中心而不是社区医院的治疗中受益的患者。
方法：在我们的社区环境中确定了接受选择性复杂腹部疝修补术的患者，并于2016年至2019年进行了治疗。然后将这些结果与ACHQC数据库中的学术中心进行比较。复杂疝的定义仅限于那些经历过任何肌筋膜前移手术的人。获得知情同意，研究获得IRB批准。所有数据都被去识别。
结果：共有180例患者在我们社区医院接受了复杂的腹部疝修补术。ACHQC数据库确定了参与学术中心符合标准的6299名患者。两组的人口统计学特征相似，包括疝气分级，大小和伤口等级。学术中心倾向于有先前成分分离（25.7％对10.6％）和免疫抑制（7.2％对2.8％）的患者，而社区医院患者包括更多的吸烟患者(18.9%vs12.1%)和高血压患者(65%vs54.9%)。社区医院的手术时间明显减少，在学术中心需要>240分钟修复时间的患者(39.6%vs5%)。社区医院组术后平均住院时间为3.7天，而学术中心为6天（P<0.05）。尽管社区医院组的总体并发症较少（26.5％vs19.4％）。在社区医院组中，30天内再次入院的频率几乎是社区医院组的两倍（14.4％vs7.7％）。
结论：在大多数病例中，社区医院可以提供与主要学术中心相当的护理和外科专业知识。有必要进行专门的护理协调，并对支持人员进行持续审查，以确保高质量的护理。仍然需要确定哪些患者将从学术中心而不是社区医院的治疗中受益，以便在两种类型的医院环境中最大化患者的访问和结果。需要对患者应转移到学术中心进行复杂的疝气护理的标准进行进一步的调查。应继续调查确定将从学术中心而不是社区医院的治疗中受益的患者。
