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

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.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Neumayer LA,Gawande AA,Wang J,Giobbie-Hurder A,Itani KM,Fitzgibbons RJ Jr,Reda D,Jonasson O,CSP #456 Investigators.

doi

10.1097/01.sla.0000179644.02187.ea

subject

Has Abstract

pub_date

2005-09-01 00:00:00

pages

344-8; discussion 348-52

issue

3

eissn

0003-4932

issn

1528-1140

pii

00000658-200509000-00005

journal_volume

242

pub_type

临床试验,杂志文章,多中心研究,随机对照试验
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