Gender disparities in the utilization of laparoscopic groin hernia repair

Cornelius A. Thiels, Kimberly A. Holst, Daniel S. Ubl, Travis J. McKenzie, Martin D. Zielinski, David R. Farley, Elizabeth B Habermann, Juliane Bingener

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Clinical treatment guidelines have suggested that laparoscopic hernia repair should be the preferred approach in both men and women with bilateral or recurrent elective groin hernias. Anecdotal evidence suggests, however, that women are less likely to undergo a laparoscopic repair than men, and therefore, we aimed to delineate if these disparities persisted after controlling for patient factors and comorbidities. Materials and methods The American College of Surgeons National Surgical Quality Improvement Project data were abstracted for all elective groin hernia repairs between 2005 and 2014. Univariate analysis was used to compare rates of laparoscopic surgery between men and women. Multivariable analysis was performed, controlling for patient demographics, preoperative comorbidities, and year of surgery. Results Over the 10-y period, 141,490 patients underwent elective groin hernia repair, of which 13,325 were women (9.4%). The rate of general anesthesia utilization was high in both men (81.3%) and women (77.2%) with 75.1% of open repairs being performed under general anesthesia. Overall, 20.2% of women underwent laparoscopic repair compared with 28.0% of men (P < 0.01). Women tended to be older, had a lesser body mass index, and slightly greater American Anesthesia Association (all P < 0.05). On multivariable regression, women had decreased odds of undergoing a laparoscopic approach compared with men (odds ratio: 0.70; 95% confidence interval, 0.67-0.73, P < 0.01). Conclusions In the elective setting, women were less likely to undergo laparoscopic repair of groin hernias than men. Although we are unable to ascertain underlying causes for these gender disparities, these data suggest that there remains a disparity in the management of groin hernias in women.

Original languageEnglish (US)
Pages (from-to)59-68
Number of pages10
JournalJournal of Surgical Research
Volume210
DOIs
StatePublished - Apr 1 2017

Fingerprint

Groin
Herniorrhaphy
Hernia
General Anesthesia
Comorbidity
Quality Improvement
Laparoscopy
Body Mass Index
Anesthesia
Odds Ratio
Demography
Guidelines
Confidence Intervals

Keywords

  • Disparities
  • Gender
  • Hernia
  • Inguinal hernia
  • NSQIP
  • Women

ASJC Scopus subject areas

  • Surgery

Cite this

Thiels, C. A., Holst, K. A., Ubl, D. S., McKenzie, T. J., Zielinski, M. D., Farley, D. R., ... Bingener, J. (2017). Gender disparities in the utilization of laparoscopic groin hernia repair. Journal of Surgical Research, 210, 59-68. https://doi.org/10.1016/j.jss.2016.10.028

Gender disparities in the utilization of laparoscopic groin hernia repair. / Thiels, Cornelius A.; Holst, Kimberly A.; Ubl, Daniel S.; McKenzie, Travis J.; Zielinski, Martin D.; Farley, David R.; Habermann, Elizabeth B; Bingener, Juliane.

In: Journal of Surgical Research, Vol. 210, 01.04.2017, p. 59-68.

Research output: Contribution to journalArticle

Thiels, CA, Holst, KA, Ubl, DS, McKenzie, TJ, Zielinski, MD, Farley, DR, Habermann, EB & Bingener, J 2017, 'Gender disparities in the utilization of laparoscopic groin hernia repair', Journal of Surgical Research, vol. 210, pp. 59-68. https://doi.org/10.1016/j.jss.2016.10.028
Thiels CA, Holst KA, Ubl DS, McKenzie TJ, Zielinski MD, Farley DR et al. Gender disparities in the utilization of laparoscopic groin hernia repair. Journal of Surgical Research. 2017 Apr 1;210:59-68. https://doi.org/10.1016/j.jss.2016.10.028
Thiels, Cornelius A. ; Holst, Kimberly A. ; Ubl, Daniel S. ; McKenzie, Travis J. ; Zielinski, Martin D. ; Farley, David R. ; Habermann, Elizabeth B ; Bingener, Juliane. / Gender disparities in the utilization of laparoscopic groin hernia repair. In: Journal of Surgical Research. 2017 ; Vol. 210. pp. 59-68.
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abstract = "Background Clinical treatment guidelines have suggested that laparoscopic hernia repair should be the preferred approach in both men and women with bilateral or recurrent elective groin hernias. Anecdotal evidence suggests, however, that women are less likely to undergo a laparoscopic repair than men, and therefore, we aimed to delineate if these disparities persisted after controlling for patient factors and comorbidities. Materials and methods The American College of Surgeons National Surgical Quality Improvement Project data were abstracted for all elective groin hernia repairs between 2005 and 2014. Univariate analysis was used to compare rates of laparoscopic surgery between men and women. Multivariable analysis was performed, controlling for patient demographics, preoperative comorbidities, and year of surgery. Results Over the 10-y period, 141,490 patients underwent elective groin hernia repair, of which 13,325 were women (9.4{\%}). The rate of general anesthesia utilization was high in both men (81.3{\%}) and women (77.2{\%}) with 75.1{\%} of open repairs being performed under general anesthesia. Overall, 20.2{\%} of women underwent laparoscopic repair compared with 28.0{\%} of men (P < 0.01). Women tended to be older, had a lesser body mass index, and slightly greater American Anesthesia Association (all P < 0.05). On multivariable regression, women had decreased odds of undergoing a laparoscopic approach compared with men (odds ratio: 0.70; 95{\%} confidence interval, 0.67-0.73, P < 0.01). Conclusions In the elective setting, women were less likely to undergo laparoscopic repair of groin hernias than men. Although we are unable to ascertain underlying causes for these gender disparities, these data suggest that there remains a disparity in the management of groin hernias in women.",
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