Pediatric Surgeons' Adoption of an Innovative Laparoscopic Technique for Inguinal Hernia Repair: A Mixed Methods Study
Pediatric Surgeons' Adoption of an Innovative Laparoscopic Technique for Inguinal Hernia Repair: A Mixed Methods Study
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DOI：
10.1089/lap.2021.0179
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发表时间：
2021-05-27
影响因子：
1.3
通讯作者：
Herrinton, Lisa J.
中科院分区：
文献类型：
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作者：
Altschuler, Andrea;Chong, Albert J.;Herrinton, Lisa J.
目的：我们研究了一种创新的腹腔镜技术在儿科外科医生和儿科泌尿科医生对小儿腹股沟疝修补术的应用。方法：这项混合方法研究包括2017-2019年接受腹股沟疝修补术的儿童及其外科医生。我们检查了外科医生对创新技术的采用和使用以及同侧复发和对侧异时修复的比率。对外科医生进行深入访谈，以确定关于采用外科创新的态度和做法的主题。结果：平均随访1.5年，开放式手术无同侧复发，而平均随访1.3年，1.54%（7/453）的单侧和0.50%（3/606）的双侧创新手术需要同侧修复。单侧手术中，对侧异时修复的开放手术占1.63%(8/490)，创新手术占0.44%（2/453）。外科医生访谈确定了继续学习和改变的方法；部门文化、规范和资源的作用；以及儿科手术和儿科腹股沟疝修复的技术问题。结论：随着时间的推移，学习的结果可能会有所改善。外科医生和科室的差异影响了采用的速度。外科医生将采用新技术时使用的合议制模式与培训期间使用的学徒制模式联系起来。我们建议研究学院模式，以提高循证外科创新的转化为实践。
Purpose: We studied adoption of an innovative laparoscopic technique for pediatric inguinal hernia repair by pediatric surgeons and pediatric urologists following dissemination of evidence for its benefits.Methods: This mixed methods study included children who received inguinal hernia repairs during 2017-2019 and their surgeons. We examined surgeons' adoption and use of the innovative technique and rates of ipsilateral recurrence and metachronous contralateral repair. In-depth interviews with surgeons were used to identify themes regarding attitudes and practices regarding the adoption of surgical innovations.Results: No ipsilateral recurrences were noted among open repairs after 1.5 years of average follow-up, while 1.54% (7/453) of unilateral and 0.50% (3/606 sides) of bilateral innovative surgeries required ipsilateral repair after 1.3 years of average follow-up. Among unilateral cases, metachronous contralateral repairs were performed in 1.63% (8/490) of open and 0.44% (2/453) of innovative surgeries. Surgeon interviews identified approaches to continued learning and change; the role of departmental culture, norms, and resources; and technical issues specific to pediatric surgery and pediatric inguinal hernia repair.Conclusions: Outcomes may have improved over time as a consequence of learning. Differences among surgeons and departments influenced the speed of adoption. Surgeons linked the collegial model used when adopting the new technique to the apprenticeship model used during their training. We propose research into the collegial model to improve translation of evidence-based surgical innovations into practice.