Background
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.
Methods
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.
Results
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).
Conclusion
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.
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Article info
Publication history
Published online: May 30, 2015
Accepted:
March 13,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
