PDF(Pubmed)
Abstract：
Aim: Hernia registries report that guidelines are not always implemented by general surgeons and suggest that the success rate of this procedure is higher in hernia specialty centers. There are many definitions of hernia centers, but their objectives consist of improving healthcare by homogenizing the clinical practice. We performed a systematic review and meta-analysis to analyze hernia centers\' definitions and compare hernia centers with non-specialized centers. Material and Methods: Cochrane Central, Scopus, Scielo, and PubMed were systematically searched for studies defining a hernia center or comparing hernia centers and non-specialized centers. Outcomes assessed were recurrence, surgical site events, hospital length of stay (LOS), and operative time. We performed subgroup analyses of hernia type. Statistical analysis was performed with R Studio. Results: 3,260 studies were screened and 88 were thoroughly reviewed. Thirteen studies were included. Five studies defined a hernia center and eight studies, comprising 141,366 patients, compared a hernia center with a non-specialized center. Generally, the definitions were similar in decision-making and educational requirements but differed in structural aspects and the steps required for the certification. We found lower recurrence rates for hernia centers for both inguinal (1.08% versus 5.11%; RR 0.21; 95% CI 0.19 to 0.23; p < 0.001) and ventral hernia (3.2% vs. 8.9%; RR 0.425; 95% CI 0.28 to 0.64; p < 0.001). Hernia centers also presented lower surgical site infection for both ventral (4.3% vs. 11.9%; RR 0.435; 95% CI 0.21 to 0.90; p = 0.026) and inguinal (0.1% vs. 0.52%; RR 0.15; 95% CI 0.02 to 0.99; p = 0.49) repair. Conclusion: Our systematic review and meta-analysis support that a hernia center establishment improves postoperative outcomes data. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024522263, PROSPERO CRD42024522263.
摘要：
目的：疝登记处报告说，一般外科医师并不总是实施指南，并建议在疝专科中心该手术的成功率更高。疝气中心有很多定义,但是他们的目标包括通过使临床实践均匀化来改善医疗保健。我们进行了系统评价和荟萃分析，以分析疝气中心的定义，并将疝气中心与非专科中心进行比较。材料和方法：CochraneCentral，Scopus,Scielo,和PubMed进行了系统搜索,寻找定义疝气中心或比较疝气中心和非专业中心的研究.评估的结果是复发，手术部位事件,住院时间（LOS），和手术时间。我们进行了疝类型的亚组分析。用RStudio进行统计学分析。结果：筛选了3,260项研究，彻底审查了88项。共纳入13项研究。五项研究定义了疝气中心和八项研究，包括141,366名患者,将疝气中心与非专业中心进行了比较。一般来说,这些定义在决策和教育要求上相似，但在结构方面和认证所需的步骤上有所不同。我们发现腹股沟疝中心的复发率较低（1.08%vs.5.11%；RR0.21；95%CI0.19至0.23；p<0.001）和腹侧疝（3.2%vs.8.9%；RR0.425；95%CI0.28至0.64；p<0.001）。疝中心的腹侧手术部位感染也较低(4.3%vs.11.9%；RR0.435；95%CI0.21至0.90；p=0.026）和腹股沟（0.1%与0.52%；RR0.15；95%CI0.02至0.99；p=0.49）修复。结论：我们的系统评价和荟萃分析支持建立疝气中心可以改善术后结局数据。系统审查注册：https://www。crd.约克。AC.uk/prospro/display_record.php?ID=CRD42024522263,PROSPEROCRD42024522263。
