There is currently little information regarding the impact of procedure volume on outcomes after open inguinal hernia repair in the United States. Our hypothesis was that increasing procedure volume is associated with lesser rates of reoperation and resource use.
The database of the Statewide Planning and Research Cooperative System was queried for elective open initial inguinal hernia repairs performed in New York State from 2001 to 2008 via the use of International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. Surgeon and hospital procedure volumes were grouped into tertiles based on the number of open inguinal hernia repairs performed per year. Bivariate, hierarchical mixed effects Cox proportional-hazards, and negative binomial regression analyses were performed assessing for factors associated with reoperation for recurrence, procedure time, and downstream total charges.
Among 151,322 patients who underwent open inguinal hernia repair, the overall rate of reoperation for recurrence within 5 years was 1.7% with a median time to reoperation of 1.9 years. An inverse relationship was seen between surgeon volume and reoperation rate, procedure time, and health care costs (P < .001). After we controlled for surgeon, facility, operative and patient characteristics, low-volume surgeons (<25 repairs/year) had greater rates of reoperation (hazard ratio 1.23,95% confidence interval [95% CI] 1.11–1.36), longer procedure times (incidence rate ratio 1.22, 95% CI 1.21–1.24), and greater downstream costs (incidence rate ratio 1.13,95% CI 1.10–1.17) than high-volume surgeons (≥25 repairs/year).
Surgeon volume <25 cases per year for open inguinal hernia repair was independently associated with greater rates of reoperation for recurrence, worse operative efficiency, and greater health care costs. Referral to surgeons who perform ≥25 inguinal hernia repairs per year should be considered to decrease reoperation rates and resource use.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Is surgical repair of an asymptomatic groin hernia appropriate? A review.Hernia. 2011; 15: 251-259
- Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias.Ann Surg. 2013; 258: 508-515
- Nationwide quality improvement of groin hernia repair from the Danish Hernia Database of 87,840 patients from 1998 to 2005.Hernia. 2008; 12: 1-7
- Hernias: inguinal and incisional.Lancet. 2003; 362: 1561-1571
- Patient-related risk factors for recurrence after inguinal hernia repair: a systematic review and meta-analysis of observational studies.Surg Innov. 2015; 22: 303-317
- Should operations be regionalized? The empirical relation between surgical volume and mortality.N Engl J Med. 1979; 301: 1364-1369
- Surgeon volume and operative mortality in the United States.N Engl J Med. 2003; 349: 2117-2127
- Volume of procedures and risk of recurrence after repair of groin hernia: national register study.BMJ. 2008; 336: 934-937
- Effect of subspecialty training and volume on outcome after pediatric inguinal hernia repair.J Pediatr Surg. 2005; 40: 75-80
- Laparoscopic versus open repair of inguinal hernia: a longitudinal cohort study.Surg Endosc. 2013; 27: 936-945
- Safety of laparoscopic and open approaches for repair of the unilateral primary inguinal hernia: an analysis of short-term outcomes.Am J Surg. 2014; 208: 195-201
- Differential use of coronary revascularization and hospital mortality following acute myocardial infarction.Arch Intern Med. 2003; 163: 461-466
- The effect of preoperative and hospital characteristics on costs for coronary artery bypass graft.Ann Surg. 2009; 249: 335-341
- Proficiency of surgeons in inguinal hernia repair: effect of experience and age.Ann Surg. 2005; 242 (discussion 348-52): 344-348
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27
- Open mesh versus laparoscopic mesh repair of inguinal hernia.N Engl J Med. 2004; 350: 1819-1827
- Surgeon volume plays a significant role in outcomes and cost following open incisional hernia repair.J Gastrointest Surg. 2015; 19: 100-110
- Population-based determinants of radical prostatectomy operative time.BJU Int. 2014; 113: E112-E118
- What does one minute of operating room time cost?.J Clin Anesth. 2010; 22: 233-236
- Impact of the establishment of a specialty hernia referral center.Surg Innov. 2014; 21: 572-579
- Centralization of cancer surgery: implications for patient access to optimal care.J Clin Oncol. 2009; 27: 4671-4678
- Potential benefits of the new Leapfrog standards: effect of process and outcomes measures.Surgery. 2004; 135: 569-575
- Open mesh versus non-mesh for repair of femoral and inguinal hernia.Cochrane Database Syst Rev. 2002; : CD002197
Published online: May 30, 2015
Accepted: March 13, 2015
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.