The Impact of Surgeon Adherence to Preoperative Optimization of Hernia Repairs

J Surg Res. 2021 Aug;264:8-15. doi: 10.1016/j.jss.2021.01.044. Epub 2021 Mar 18.


Background: At the patient level, optimizing risk factors before surgery is a proven approach to improve patient outcomes after hernia repair. However, nearly 25% of patients are not adequately optimized before surgery. It is currently unknown how surgeon-level adherence to preoperative optimization impacts postoperative outcomes. In this context, we evaluated the association between surgeon adherence to optimization practices and surgeon-level postoperative outcomes.

Materials and methods: Michigan Surgical Quality Collaborative data from 2014 to 2018 was analyzed to examine rates of surgeon adherence to preoperative optimization when performing elective ventral and incisional hernia repair. Adherence was defined as operating on patients who were nontobacco users with a body mass index >18.5 kg/m2 and <40 kg/m2. Surgeons were assigned a risk- and reliability-adjusted adherence rate which was used to divide surgeons into tertiles. Outcomes were compared between adherence tertiles.

Results: Across 70 hospitals in Michigan, 15,016 patients underwent ventral and incisional hernia repair, cared for by 454 surgeons. Surgeon adherence to preoperative optimization ranged from 51% to 76%. Surgeons in the lowest optimization tertile had higher rates of emergency department visits (8.78% versus 7.05% versus 7.03%, P < 0.001), serious complications (2.12% versus 1.56% versus 1.84%, P = 0.041), and any complication (4.08% versus 3.37% versus 4.04%, P = 0.043), than middle and high optimization tertiles.

Conclusions: Surgeons' clinical outcomes, including complication rates, are affected by the proportion of their patients who are preoperatively optimized with regard to obesity and tobacco use. These results suggest that surgeons can improve their postoperative outcomes by addressing these issues before surgery.

Keywords: Hernia repair; Patient characteristics; Postoperative complications; Preoperative optimization; Surgeon postoperative outcomes.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Elective Surgical Procedures / adverse effects
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Hernia, Ventral / surgery
  • Herniorrhaphy / adverse effects*
  • Humans
  • Incisional Hernia / surgery
  • Male
  • Middle Aged
  • Obesity / epidemiology
  • Obesity / therapy
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Practice Guidelines as Topic
  • Preoperative Care / standards*
  • Preoperative Care / statistics & numerical data
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Smoking Cessation
  • Surgeons / standards
  • Surgeons / statistics & numerical data*
  • Tobacco Smoking / epidemiology
  • Tobacco Smoking / therapy