Capella 4025 Assessment 1

Capella 4025 Assessment 1

Student 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 surgery, surgical recurrence, laparoscopic procedures, open repair, ventral hernias, postoperative outcomes, comparative surgical evaluation.

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

The following table outlines a critical appraisal of the research conducted by Fry et al. (2024), which investigates the impact of surgical technique on long-term recurrence after ventral hernia repair.

Criteria	Review
Study Type	The paper employed a retrospective cohort methodology using Medicare claims, placing it in the category of observational research.
Level of Evidence	As a non-randomized, retrospective analysis using instrumental variables, it aligns with Level III evidence.
Methodology	Over 161,000 patients who underwent ventral hernia procedures were analyzed. The authors applied regional robotic adoption as an instrumental variable and used Cox regression models to determine recurrence risks.
Credibility Factors	The study’s robustness stems from its large, national sample, a 10-year follow-up span, and comprehensive statistical modeling. Publishing in a high-impact, peer-reviewed journal (JAMA Surgery) further validates its credibility.
Importance of Diagnosis	Ventral hernias are frequently encountered in surgical practice. Determining the most effective technique to reduce recurrence informs clinical pathways and patient outcomes.
Application in Clinical Setting	The findings suggest cautious application of robotic-assisted surgery due to its slightly elevated recurrence rate. This is particularly relevant for elderly patients and should guide clinical decision-making.

Sentinel U Patient Case Study

Patient Name: Todd Shoemaker Clinical Focus: Monitoring postoperative status following ventral hernia repair

In the immediate postoperative period, clinical care for Todd Shoemaker emphasizes vigilance for complications such as infection, bleeding, and delayed wound recovery. He is managed with standard post-surgical protocols, including routine pain control using oral analgesics, wound inspection, and infection monitoring. His diet is unrestricted, and physical mobility is supported within tolerance levels.

By postoperative day two, Todd is making favorable progress. He is ambulating, tolerating food, and has minimal pain complaints. As a result, his level of care has been downgraded from acute. Discharge preparations include education on wound care, signs of infection, and the importance of follow-up care. Early mobilization, vital sign checks, and ongoing assessments have been integral to his smooth recovery.

Capella 4025 Assessment 1

Summary of Findings

Fry et al. (2024) analyzed 161,415 cases of Medicare patients who underwent ventral hernia surgery between 2010 and 2020. The study compared outcomes among three surgical techniques: robotic-assisted, laparoscopic, and open repair. The 10-year recurrence rates were 13.4% for robotic procedures, 12.3% for laparoscopic, and 12.7% for open surgeries. Risk comparisons through hazard ratios indicated that laparoscopic surgery (HR 0.78; 95% CI, 0.62–0.94) and open repair (HR 0.81; 95% CI, 0.64–0.97) significantly outperformed robotic-assisted approaches in reducing long-term recurrence.

These differences remained consistent even when surgeon experience levels were accounted for, emphasizing that the choice of technique plays a significant role in long-term success. In Todd Shoemaker’s case, understanding the surgical method used is critical to planning his long-term care. If he underwent robotic-assisted surgery, clinicians should recognize the higher potential for recurrence, which is approximately 1.1% greater than laparoscopic and 0.7% greater than open techniques.

Relevance and Potential Effectiveness of Evidence

The evidence presented by Fry et al. (2024) is particularly impactful for institutions managing geriatric surgical populations. The research, focused on Medicare beneficiaries with an average age of 69, presents compelling data for guiding surgical decisions. The modest yet notable recurrence rate associated with robotic-assisted repair suggests a more measured approach in selecting surgical techniques, particularly for straightforward cases where traditional approaches may yield superior durability.

In Todd Shoemaker’s situation, even though he is experiencing an uncomplicated recovery, his care team should factor in the elevated recurrence risks when preparing for discharge. This may include plans for enhanced follow-up, such as imaging or scheduled outpatient assessments. Hospitals expanding robotic programs should integrate this evidence into policy development, ensuring that patient selection, procedural planning, and post-operative management are aligned with long-term outcomes. The study supports a balanced, evidence-driven application of robotic-assisted techniques tailored to individual patient profiles.

---

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