Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study

Methods: Surgeons' individual annual case volumes were calculated from a retrospectively collected data set of pediatric inguinal hernia repairs including 21 hospitals from 2017 to 2019. Quartiles were defined based on surgeons' annual case volumes for each year: Lower Volume = Q1-3 and Higher Volume = Q4. Descriptive statistics and bivariate regression were utilized for analysis.

Results: For all repair techniques, there were 207 surgeons accounting for 548 surgeon-years with 8519 operations. For all repairs, Higher Volume was defined as > 22 operations per year. On regression analysis, presence of a ventriculoperitoneal shunt, peritoneal dialysis, laparoscopic technique, and surgery performed by a lower volume surgeon were associated with recurrence risk. For open repairs, there were 193 surgeons, 465 surgeon-years, and 5726 operations. Higher Volume was defined as >18 operations per year. On regression analysis, history of an omphalocele, a connective tissue disorder, and tracheostomy dependence contributed to recurrence risk, while surgeon volume did not. For laparoscopic repairs, there were 136 surgeons, 306 surgeon-years, and 2793 operations. High Volume was defined as >14 operations per year. On regression analysis, presence of a ventriculoperitoneal shunt and surgeon laparoscopic volume was associated with recurrence risk.

Conclusions: Annual surgical volume is an important determinant of recurrence following laparoscopic inguinal hernia repair. As surgeons integrate both laparoscopic and open techniques in their practice, caution should be taken to maintain adequate volume and proficiency in each technique.