Factors that influence surgeon deviation from practice guidelines for the management of inguinal hernia repair include surgeon preferences and access to resources (JAMA Netw Open. 2020;3[11]:e2023684. doi:10.1001/jamanetworkopen.2020.23684).
Many patients receive care that deviates from available evidence-based guidelines for surgery, but reasons for this are unknown.
In a qualitative study, researchers aimed “to explore factors associated with surgeon choice of approach (minimally invasive vs open) in inguinal hernia repair as a tool to gain an understanding of guideline-discordant care,” according to Anne Ehlers, MD, MPH, University of Michigan (Ann Arbor, MI) and colleagues.
The study was performed as part of a larger explanatory sequential mixed methods design, and purposive sampling was used to recruit practicing surgeons. Qualitative interviews with 21 surgeons diverse in practice type, geographic location, and surgical specialties were performed. Data were collected between April 24 and July 31, 2018 and evaluated through statistical analysis.
Researchers identified 3 major themes that influenced the choice of approach for inguinal hernia repair: surgeon preference and autonomy, availability of and access to minimally invasive technologies, and patient characteristics.
“Addressing surgeon preference and available resources may provide an opportunity to optimize care for patients undergoing inguinal hernia repair, while understanding these motivations may also inform questions of guideline-discordant care more broadly in surgery,” explained Dr Ehlers and colleagues.—Lisa Kuhns
