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Invited Critique
January 2011January 17, 2011

Surgical Registries: Effective, but How to Pay for Them?Comment on “More Recurrences After Hernia Mesh Fixation With Short-term Absorbable Sutures”

Author Affiliations

Author Affiliations: Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Administration Hospital, Birmingham, Alabama, and Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham.

Arch Surg. 2011;146(1):17. doi:10.1001/archsurg.2010.273

Registries such as the nationwide SHR are powerful tools to evaluate adoption of practices and their effectiveness. Surgical registries are of particular importance as technical aspects and patient factors can be analyzed together to determine the effectiveness of an operation. Novik et al reported that during an 8-year study period, 1.5% of Lichtenstein inguinal hernias had mesh fixation with short-term absorbable suture. Although there was no significant increase of that practice during the observation period, mesh fixation with short-term absorbable suture had a greater than 2-fold hazard of reoperation due to hernia recurrence. Mesh fixation methods have been implicated as a potential cause of chronic groin pain following inguinal hernioplasty. In trying to improve outcomes for patients, surgeons adopted an unexpectedly less effective practice. Without a nationwide registry, this finding may have taken much longer to become apparent.