Surgeon volume plays a significant role in outcomes and cost following open incisional hernia repair

Abstract

Title: Surgeon Volume Plays a Significant Role in Outcomes and Cost Following Open Incisional Hernia Repair

Purpose: Incisional hernia is a common complication following gastrointestinal surgery. Many surgeons elect to perform incisional hernia repairs despite performing only limited numbers of hernia repairs annually. This study examines the relationship between surgeon/facility volume and operative time, reoperation rates, and cost following initial open hernia repair.

Methods: The New York Statewide Planning and Research Cooperative System was queried for elective open initial incisional hernias repairs from 2001 to 2006. Surgeon/facility volumes were calculated as mean number of open incisional hernia repairs per year from 2001 to 2006. Reoperations for recurrent hernia over a 5-year period were identified using ICD-9/CPT codes. Multivariable regression was used to compare patient, surgeon, and facility characteristics with operative time, hernia reoperation, and hospital charges.

Results: Eighteen thousand forty-seven patients met the inclusion criteria. The hernia reoperation rate was 9%, and median time to reoperation was 1.4 years (mean = 1.8). After adjusting for clinical factors, surgeons performing an average of ≥36 repairs/year had significantly lower reoperation rates (HR = 0.59, 95% confidence interval (CI) = 0.48,0.72), operative time (incidence rate ratio (IRR) = 0.67, 95% CI = 0.64,0.71), and downstream charges (IRR = 0.63, 95% CI = 0.57,0.69). Facility characteristics (volume, academic affiliation, location) were not associated with reoperation.

Conclusions: This study found a strong association between individual surgeon incisional hernia repair volume and hernia reoperation rates, operative efficiency, and charges. Preferential referral to high-volume surgeons may lead to improved outcomes and lower costs.