Surgeon Variation in the Application of Robotic Technique for Abdominal Hernia Repair: A Mixed-Methods Study

Lia D Delaney; Jyothi Thumma; Ryan Howard; Quintin Solano; Brian Fry; Justin B Dimick; Dana A Telem; Anne P Ehlers

doi:10.1016/j.jss.2022.05.008

Surgeon Variation in the Application of Robotic Technique for Abdominal Hernia Repair: A Mixed-Methods Study

J Surg Res. 2022 Nov:279:52-61. doi: 10.1016/j.jss.2022.05.008. Epub 2022 Jun 16.

Authors

Lia D Delaney¹, Jyothi Thumma², Ryan Howard³, Quintin Solano¹, Brian Fry³, Justin B Dimick⁴, Dana A Telem⁴, Anne P Ehlers⁵

Affiliations

¹ University of Michigan Medical School, Ann Arbor, Michigan.
² Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
³ Department of Surgery, University of Michigan, Ann Arbor, Michigan.
⁴ Department of Surgery, University of Michigan, Ann Arbor, Michigan; Division of Minimally Invasive Surgery, Department of Surgery, Ann Arbor, Michigan.
⁵ Department of Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: aehlers@med.umich.edu.

PMID: 35717796
DOI: 10.1016/j.jss.2022.05.008

Abstract

Introduction: Although the utilization of robotic technique for abdominal hernia repair has increased rapidly, there is no consensus as to when it should be applied for optimal outcomes. High variability exists within surgeon practices regarding how they use this technology, and the factors that drive robotic utilization remain largely unknown. This study aims to explore the motivating factors associated with surgeons' decisions to utilize a robotic approach for abdominal hernia repair.

Methods: An exploratory mixed-methods approach was utilized. Surgeons who performed abdominal hernia repairs were interviewed to identify impactful themes motivating surgical approach. This informed a retrospective analysis of ventral hernia repairs performed in 2020 within the Michigan Surgical Quality Collaborative. Surgeon robotic utilization rates were calculated. Among selective robotic users, multivariable regression evaluated the patient and hernia factors associated with robotic utilization.

Results: Qualitative analysis of 21 interviews revealed three dominant themes in the decision to utilize robotic technology: access and resources, surgeon comfort, and market factors. Among 71 surgeons caring for 1174 hernia patients, robotic utilization rates ranged from 0% to 98% of cases. There were 27 surgeons identified as selective robotic users, who cared for 423 patients. Multivariable regression revealed that hernia location was the only factor associated with robotic technique, with non-midline hernias associated with a 4.47 (95% confidence interval 1.34-14.88) higher odds of robotic repair than epigastric hernias.

Conclusions: Major drivers of robotic technique for hernia repair were found to be perceived benefits and availability, rather than patient or hernia characteristics. These data will contribute to an understanding of surgeon decision-making and help develop improvements to patient care.

Keywords: Hernia repair; Mixed methods; Operative technique; Robot; Surgeon decision-making.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Research Support, N.I.H., Extramural

MeSH terms

Hernia, Ventral* / surgery
Herniorrhaphy / adverse effects
Herniorrhaphy / methods
Humans
Laparoscopy* / methods
Retrospective Studies
Robotic Surgical Procedures*
Surgeons*
Surgical Mesh