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

Ann Surg. 2005 Sep;242(3):344-8; discussion 348-52. doi: 10.1097/01.sla.0000179644.02187.ea.


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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Clinical Competence
  • Cross-Sectional Studies
  • Hernia, Inguinal / epidemiology
  • Hernia, Inguinal / pathology
  • Hernia, Inguinal / surgery*
  • Humans
  • Laparoscopy / standards
  • Laparoscopy / statistics & numerical data
  • Middle Aged
  • Recurrence
  • Surgical Procedures, Operative / standards*
  • Surgical Procedures, Operative / statistics & numerical data
  • United States