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- Title
Surgeon variability in repair of hiatal hernia at the time of bariatric surgery.
- Authors
Valukas, Catherine S.; Vitello, Dominic; Sanchez, Joseph; Soetikno, Alan; Prinz, Joanne; Hungness, Eric S.; Teitelbaum, Ezra N.
- Abstract
Background: Hiatal hernia (HH) is estimated to affect between 20 and 50% of patients undergoing bariatric surgery. However, there is no consensus regarding the preoperative assessment and intraoperative repair of HH. The aim of this study was to evaluate the variation in surgeon assessment and repair of HH during bariatric surgery across a multi-hospital healthcare system. Methods: A retrospective cohort analysis was conducted using data obtained from the metabolic and bariatric accreditation quality improvement program (MBSAQIP) and institutional medical records. All adult patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) were included. Preoperative assessment of HH was defined as either EGD or upper GI/Esophagram (UGI) within one year of surgery. Surgeons were evaluated individually and by hospital. Chi-square analysis and ANOVA were performed. Results: From January 2018 to February 2023, 3,487 bariatric surgeries were performed across 4 hospitals and 11 surgeons (2481 SG and 1006 RYGB). HH were concurrently repaired during 24% of operations. The rate of HH repair in SG was 25 and 22% in RYGB (p = 0.06). Preoperatively, 41% of patients underwent EGD and 23% had an UGI. HH was diagnosed in 22% of EGDs. Patients who underwent preoperative EGD had higher rates of HH repair than those without a preop EGD (33% vs. 17%; p < 0.001). The rate of preoperative EGD utilization by surgeon varied significantly from 3 to 92% (p < 0.001) as did HH repair rates between surgeons (range 8–57%; p < 0.001). Even among patients with a preoperatively diagnosed HH, the repair rate ranged 20–91% between individual surgeons (p < 0.001). Conclusion: Within a healthcare system there was significant heterogeneity in approach to assessment and repair of HH during bariatric surgery. This appears to be mediated by multiple factors, including utilization of preoperative studies, individual surgeon differences, and differences between hospitals.
- Subjects
GASTROESOPHAGEAL reflux diagnosis; HERNIA surgery; BARIATRIC surgery; GASTRECTOMY; PREOPERATIVE period; DATA analysis; RESEARCH funding; HERNIA; SCIENTIFIC observation; LAPAROSCOPIC surgery; RETROSPECTIVE studies; CHI-squared test; DESCRIPTIVE statistics; LONGITUDINAL method; ROUTINE diagnostic tests; PHYSICIAN practice patterns; MEDICAL records; ACQUISITION of data; ANALYSIS of variance; STATISTICS; DATA analysis software; GASTRIC bypass; SENSITIVITY &; specificity (Statistics)
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2024, Vol 38, Issue 9, p5017
- ISSN
1866-6817
- Publication type
Article
- DOI
10.1007/s00464-024-11048-7