Capella 4025 Assessment 1

Name

Capella university

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

Analyzing a Research Paper

Figure 1: Research Article

Keywords: Robotic-assisted hernia repair, operative recurrence, laparoscopic method, open hernia surgery, ventral hernia, post-surgical results, comparison of surgical techniques.

Reference

Fry, B. T., Howard, R. A., Thumma, J. R., Norton, E. C., Dimick, J. B., & Sheetz, K. H. (2024). Surgical approach and long-term recurrence after ventral hernia repair. The Journal of the American Medical Association Surgery, 159(9), 1019–1028. https://doi.org/10.1001/jamasurg.2024.1696

Date of Publication: September 1, 2024

Article Review

Criteria	Review
Study Type	This research employed a retrospective cohort design utilizing Medicare claims data, categorizing it as an observational study.
Level of Evidence	Classified as Level III evidence due to its non-randomized, retrospective structure enhanced with instrumental variable analysis.
Methodology	The investigators analyzed data from over 161,000 Medicare recipients who underwent ventral hernia surgeries. Instrumental variable analysis based on regional robotic surgery adoption was applied to reduce bias, followed by Cox regression models for recurrence analysis.
Credibility Factors	The study’s credibility is strengthened by its extensive national sample, 10-year follow-up period, and sophisticated statistical techniques. The peer-reviewed nature of the JAMA Surgery publication further validates its reliability.
Importance of Selected Diagnosis	Ventral hernia is a prevalent surgical condition. Understanding which surgical approach minimizes recurrence supports better outcomes and guides clinical and surgical decisions.
Application in Workplace/Patient Population	The outcomes of this study have practical implications for surgical practice and policy-making. Given the higher recurrence rates associated with robotic-assisted repairs, clinicians are advised to cautiously consider its broad implementation, especially among older adults.

Sentinel U Patient Case Study

Patient Name: Todd Shoemaker Clinical Focus: Post-operative progress following ventral hernia surgery Initial Observations: After the operation, immediate attention is directed toward detecting signs of infection, hemorrhage, or delayed wound healing.

Treatment Plan: Todd is receiving routine post-surgical care, which includes oral pain medication, routine wound assessment, and infection surveillance. His diet is unrestricted, and physical activity is encouraged as tolerated.

Care Summary: By the second postoperative day, Todd is showing good recovery. He is managing pain effectively, eating a normal diet, and preparing for discharge. Given his stability and minimal care needs, his acute care level has been downgraded. Care interventions included early ambulation, vital signs monitoring, and wound care education for home recovery.

Capella 4025 Assessment 1

Summary of Findings

The study by Fry et al. (2024) examined 161,415 Medicare patients undergoing ventral hernia repair from 2010 to 2020 using robotic-assisted, laparoscopic, and open methods. The results demonstrated that robotic-assisted surgery had the highest 10-year cumulative recurrence rate at 13.4%, compared to 12.3% for laparoscopic and 12.7% for open procedures. Hazard ratio comparisons indicated that laparoscopic (HR 0.78; 95% CI, 0.62–0.94) and open (HR 0.81; 95% CI, 0.64–0.97) repairs were associated with significantly lower recurrence risks relative to robotic techniques. Importantly, these patterns persisted across different surgeon volumes, implying that the surgical approach itself may influence long-term outcomes. In the case of Todd Shoemaker, who is two days post-op with favorable recovery metrics, awareness of the surgical approach used is essential for long-term planning. If Todd underwent a robotic-assisted procedure, providers should be vigilant, as recurrence risk over a decade is higher by approximately 1.1% compared to laparoscopic and 0.7% compared to open repair techniques.

Relevance and Potential Effectiveness of Evidence

The evidence provided by Fry et al. (2024) offers significant value for hospitals treating older adult surgical populations, as the study’s cohort primarily comprised Medicare beneficiaries with an average age of 69 years. Institutions utilizing robotic surgery platforms must consider the slightly increased recurrence rate when determining surgical plans, especially for uncomplicated hernias where traditional techniques may yield better durability. Todd Shoemaker represents a typical patient from the study’s demographic.

Although he is recovering well, his care team should include recurrence risk in discharge planning, particularly if robotic surgery was involved. Early follow-up, possibly involving imaging or close outpatient monitoring, may be necessary to mitigate long-term complications. For healthcare centers increasingly adopting robotic techniques, this research supports more selective usage tailored to patient-specific factors, procedural risk, and follow-up resources. Ultimately, the study advocates for a data-driven and patient-centered approach when considering robotic-assisted hernia repair in elective scenarios.

Article Link: JAMA Surgery Article

References

Fry, B. T., Howard, R. A., Thumma, J. R., Norton, E. C., Dimick, J. B., & Sheetz, K. H. (2024). Surgical approach and long-term recurrence after ventral hernia repair. The Journal of the American Medical Association Surgery, 159(9), 1019–1028. https://doi.org/10.1001/jamasurg.2024.1696

Capella 4025 Assessment 1