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Ann Surg. 2005 Sep;242(3):344-8; discussion 348-52.

Proficiency of surgeons in inguinal hernia repair: effect of experience and age.

Author information

1
VA Salt Lake City Health Care System, University of Utah Health Sciences Center, Salt Lake City, UT 84148, USA. leigh.neumayer@hsc.utah.edu

Abstract

OBJECTIVES:

We examined the influence of surgeon age and other factors on proficiency in laparoscopic or open hernia repair.

SUMMARY BACKGROUND DATA:

In a multicenter, randomized trial comparing open and laparoscopic herniorrhaphies, conducted in Veterans Administration hospitals (CSP 456), we reported significant differences in recurrence rates (RR) for the laparoscopic procedure as a result of surgeons' experience. We have also reported significant differences in RR for the open procedure related to resident postgraduate year (PGY) level.

METHODS:

We analyzed data from unilateral laparoscopic and open herniorrhaphies from CSP 456 (n = 1629). Surgeon's experience (experienced > or =250 procedures; inexperienced <250), surgeon's age, median PGY level of the participating resident, operation time, and hospital observed-to-expected (O/E) ratios for mortality were potential independent predictors of RR.

RESULTS:

Age was dichotomized into older (> or =45 years) and younger (<45 years). Surgeon's inexperience and older age were significant predictors of recurrence in laparoscopic herniorrhaphy. The odds of recurrence for an inexperienced surgeon aged 45 years or older was 1.72 times that of a younger inexperienced surgeon. For open repairs, although surgeon's age and operation time appeared to be related to recurrence, only median PGY level of <3 was a significant independent predictor.

CONCLUSION:

This analysis demonstrates that surgeon's age of 45 years and older, when combined with inexperience in laparoscopic inguinal herniorrhaphies, increases risk of recurrence. For open repairs, only a median PGY level of <3 was a significant risk factor.

[Indexed for MEDLINE]
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