Dr Leigh Neumayer and colleagues examined the influence of surgeon age and other factors on proficiency in laparoscopic or open hernia repair.
The investigators conducted a multicenter, randomized trial comparing open and laparoscopic herniorrhaphies in Veterans Administration hospitals.
The investigative team reported significant differences in recurrence rates for the laparoscopic procedure as a result of surgeons' experience.
The team also reported significant differences in recurrence rates for the open procedure related to resident postgraduate year level.
Data from 1629 unilateral laparoscopic and open herniorrhaphies from the hospitals was analyzed.
Surgeon's experience was assessed as experienced with more than or equal to 250 procedures and inexperienced with less than 250 procedures.
The team assessed surgeon's age, median postgraduate year level of the participating resident, and operation time.
| For open repairs, a median postgraduate years of less than 3 was a significant risk factor|
|Annals of Surgery|
Experience was also assessed and hospital observed-to-expected ratios for mortality as potential independent predictors of recurrence rates.
The investigators reported that age was dichotomized into equal to or more than 45 years and less than 45 years.
The team observed that 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 2 times that of a younger inexperienced surgeon.
For open repairs, surgeon's age and operation time appeared to be related to recurrence.
In addition, the team noted that only median postgraduate year level of less than 3 was an independent predictor.
Dr Neumayer's team concludes, “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 postgraduate years of less than 3 was a significant risk factor.”