THE IMPORTANCE OF HERNIA CENTERS TO IMPROVE ABDOMINAL WALL RECONSTRUCTION OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Aim Hernia registries report that general surgeons do not always implement guidelines and suggest that the success rate of this procedure is higher in hernia specialty centers. There are many definitions of hernia centers, but their objectives consist of improving health care by homogenizing the clinical practice. We performed a systematic review and meta-analysis to analyze hernia centers' definitions and compare outcomes for inguinal and ventral hernia repairs from hernia centers with non-specialized centers. Material and Methods Cochrane Central, Scopus, Scielo, and PubMed were systematically searched for studies defining a hernia center or comparing hernia centers and non-specialized centers. Outcomes assessed were recurrence, surgical site events, hospital length of stay (LOS), and operative time (OT). Statistical analysis was performed with R Studio. Results 3,260 studies were screened and 13 studies were included. Five studies defined a hernia center and eight studies, comprising 141,366 patients, compared a hernia center with a non-specialized center. The definitions were similar, but differed in structural aspects and the steps required for the certification. We found lower recurrence rates for hernia centers for both inguinal (1.08% versus 5.11%; RR 0.21; 95% CI 0.19 to 0.23; P < 0.001) and ventral hernia (2.03% versus 4,16%; RR 0.54; 95% CI 0.3 to 0.96; P = 0.03). Hernia centers also presented lower surgical site infection (RR 0.43; 95% CI 0.21 to 0.9; P = 0.03), and hematoma (RR 0.21; 95% CI 0.06 to 0.81; P < 0.02) rates in ventral hernia repair. Conclusion Our study support that the establishment of a hernia center can improve postoperative outcomes.