ImportanceComponent separation is a reconstructive technique used to facilitate midline closure of large or complex ventral hernias. Despite a contemporary surge in popularity, the incidence and long-term outcomes after component separation remain unknown.ObjectiveTo evaluate the incidence and long-term outcomes of component separation for abdominal wall hernia repair.Design, Setting, and ParticipantsThis cohort study examined 100% Medicare administrative claims data from January 1, 2007, to December 31, 2021. Participants were adults (aged ≥18 years) who underwent elective inpatient ventral hernia repair. Data were analyzed from January through June 2024.ExposureUse of component separation technique during ventral hernia repair.Main Outcomes and MeasuresThe primary outcomes were the incidence of component separation over time and operative recurrence rates up to 10 years after surgery for hernia repairs with and without component separation. The secondary outcome was rate of operative recurrence after component separation stratified by surgeon volume.ResultsAmong 218 518 patients who underwent ventral hernia repair, the mean (SD) age of the cohort was 69.1 (10.9) years; 127 857 patients (58.5%) were female and 90 661 (41.5%) male. A total of 23 768 individuals had component separation for their abdominal wall hernia repair. The median (IQR) follow-up time after the index hernia surgery was 7.2 (2.7-10) years. Compared with patients who did not have a component separation, patients undergoing repair with component separation were slightly younger; more likely to be male; and more likely to have comorbidities, including obesity, and had surgeries that were more likely to be performed open and use mesh. Proportional use of component separation increased from 1.6% of all inpatient hernia repairs in 2007 (279 patients) to 21.4% in 2021 (1569 patients). The 10-year adjusted operative recurrence rate after component separation was lower (11.2%; 95% CI, 11.0%-11.3%) when compared with hernia repairs performed without component separation (12.9%; 95% CI, 12.8%-13.0%; P = .003). Operative recurrence was lower for the top 5% of surgeons by component separation volume (11.9%; 95% CI, 11.8%-12.1%) as opposed to the bottom 95% of surgeons by volume (13.6%; 95% CI, 13.4%-13.7%; P = .004).Conclusions and RelevanceThis study found that component separation was associated with a protective effect on long-term operative recurrence after ventral hernia repair among Medicare beneficiaries, which is somewhat unexpected given the intent of its use for higher complexity hernias. Surgeon volume, while significant, had only a minor influence on operative recurrence rates.

中文翻译：

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腹壁疝修补术成分分离的长期结果


重要性成分分离是一种重建技术，用于促进大型或复杂腹疝的中线闭合。尽管当代流行起来，但成分分离后的发生率和长期结果仍然未知。目的评价成分分离治疗腹壁疝修补术的发生率和远期结局。设计、设置和参与者该队列研究检查了 2007 年 1 月 1 日至 2021 年 12 月 31 日的 100% 医疗保险行政索赔数据。参与者是接受择期住院腹疝修复术的成人 （≥18 岁）。数据分析时间为 2024 年 1 月至 6 月。主要结局和措施主要结局是成分分离的发生率和手术后长达 10 年的疝修补术手术复发率，有和没有成分分离。次要结局是按外科医生体积分层的成分分离后手术复发率。结果在 218 518 例接受腹疝修复术的患者中，队列的平均 （SD） 年龄为 69.1 （10.9） 岁;女性 127 857 例 （58.5%） 患者，男性 90 661 例 （41.5%）。共有 23 768 例个体的腹壁疝修补术有成分分离。指数疝手术后的中位 （IQR） 随访时间为 7.2 （2.7-10） 年。与未进行成分分离的患者相比，接受成分分离修复的患者略年轻;更可能是男性;更可能患有合并症，包括肥胖，并且手术更有可能开腹并使用网片。组分分离的使用比例从 1.6 年占所有住院疝修补术的 2007%（279 名患者）到 2021 年的 21.4%（1569 名患者）。与无成分分离的疝修补术相比，成分分离后 10 年调整后的手术复发率较低 （11.2%;95% CI，11.0%-11.3%）（12.9%;95% CI，12.8%-13.0%;P = .003）。按成分分离体积计算，排名前 5% 的外科医生的手术复发率较低 （11.9%;95% CI，11.8%-12.1%），而按体积计算排名最低的 95% 的外科医生 （13.6%;95% CI，13.4%-13.7%;P = .004）。结论和相关性本研究发现，成分分离与 Medicare 受益人腹疝修复术后长期手术复发的保护作用有关，考虑到其用于更高复杂性疝的意图，这有点出乎意料。外科医生的数量虽然很大，但对手术复发率的影响很小。