Proficiency of surgeons in inguinal hernia repair: Effect of experience and age

Leigh A. Neumayer, Atul A. Gawande, Jia Wang, Anita Giobbie-Hurder, Kamal M.F. Itani, Robert J. Fitzgibbons, Domenic Reda, Olga Jonasson, Lawrence W. Way, Lazar J. Greenfield, Anthony A. Meyer, Murray F. Brennan, David I. Soybel, Quan Yang Duh, Eric W. Fonkalsrud, Donald D. Trunkey

Research output: Contribution to journalArticlepeer-review

150 Scopus citations


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 ≥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 (≥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.

Original languageEnglish (US)
Pages (from-to)344-352
Number of pages9
JournalAnnals of surgery
Issue number3
StatePublished - Sep 2005

All Science Journal Classification (ASJC) codes

  • Surgery


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