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Review
. 2024 Jul 22:3:13270.
doi: 10.3389/jaws.2024.13270. eCollection 2024.

The Impact of a Specialized Hernia Center and Standardized Practices on Surgical Outcomes in Hernia Surgery: A Systematic Review and Meta-Analysis

Carlos Andre Balthazar da Silveira  1 , Ana Caroline Dias Rasador  1 , Diego L Lima  2 , Raquel Nogueira  2 , Valberto Sanha  3 , João P G Kasakewitch  4 , Leandro T Cavazzola  5 , Prashanth Sreeramoju  2 , Flavio Malcher  6
Affiliations
Review

The Impact of a Specialized Hernia Center and Standardized Practices on Surgical Outcomes in Hernia Surgery: A Systematic Review and Meta-Analysis

Carlos Andre Balthazar da Silveira et al. J Abdom Wall Surg. .

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.

Keywords: hernia center; hernia specialist; incisional hernia; inguinal hernia; ventral hernia.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flowchart of selected studies.
FIGURE 2
FIGURE 2
Risk of bias of included studies.
FIGURE 3
FIGURE 3
Recurrence rates following VHR and IHR.
FIGURE 4
FIGURE 4
A. Surgical site infection rates following VHR and IHR.
FIGURE 5
FIGURE 5
Mortality rates following VHR.
FIGURE 6
FIGURE 6
Hematoma rates following VHR and IHR.
See this image and copyright information in PMC

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