Inguinal hernia repair in Spain. A population-based study of 263,283 patients: factors associated with the choice of laparoscopic approach.
PURPOSE
The objective of this study is to evaluate the laparoscopic inguinal hernia repair (IHR) rate in Spain and identify the factors associated with the choice of this surgical approach.


METHODS
A retrospective cohort study of 263,283 patients who underwent IHR from January 2016 to December 2018 was conducted. Data were extracted from the Spanish Minimum Basic Data Set (MBDS) of the Health Ministry database. The primary outcome was laparoscopic (LAP) rate utilization. Univariate analysis and multivariable logistic regression analysis were performed to identify factors associated with LAP-IHR.


RESULTS
Only 5.7% (15,059) patients underwent LAP-IHR, whereas the remnant 94.3% (248,224 patients) underwent open repair. High variability in the LAP-IHR rate across the country was observed; ranged between provinces from 0 to 19.7%, for a unilateral hernia, and between 0 to 57.4% in the case of bilateral hernias. On multivariate logistic regression analysis, the patient place of residence was the most remarkable factor associated with the likelihood of receiving LAP-IHR (OR 4.96; p < 0.001). There were also significant differences favoring LAP-IHR for bilateral operation (OR 4.596; p < 0.001), insurance coverage (OR 4.439, p < 0.001) and self-pay patients (OR 2.317; p < 0.001), as well as a recurrent hernia (OR 1.780; p < 0.001), age younger than 65 years (OR 1.555; p < 0.001) and male sex (OR 1.162, p < 0.001).


CONCLUSION
LAP-IHR remains a not frequent choice among surgeons in Spain, even when dealing with recurrent and bilateral hernias. The results suggest that the choice of LAP-IHR could depend on the surgeon's preference rather than on the indication appropriateness.
['Guillaumes|S|S|0000-0001-8251-6171', 'Hoyuela|C|C|0000-0002-6539-0439', 'Hidalgo|N J|NJ|', 'Juvany|M|M|', 'Bachero|I|I|', 'Ardid|J|J|', 'Martrat|A|A|', 'Trias|M|M|']
D000368:Aged D005260:Female D006552:Hernia, Inguinal D059685:Herniorrhaphy D006801:Humans D010535:Laparoscopy D008297:Male D008875:Middle Aged D012189:Retrospective Studies D013030:Spain
Inguinal hernia repair Hernia Abdominal wall surgery Hernioplasty Laparoscopy Minimally invasive surgery Surgical training