title: Effect of subspecialty training and volume on outcome after pediatric inguinal hernia repair.
abstract: OBJECTIVE
  Inguinal hernia repair is the most common operation performed in children. The aim of this study was to determine if there are any differences in outcome when this procedure is performed by subspecialist pediatric surgeons when compared with general surgeons.
  
  
  METHODS
  All pediatric inguinal hernias repaired in the province of Ontario between 1993 and 2000 were reviewed using a population-based database. Children with complex medical conditions or prematurity were excluded. Cases done by general surgeons were compared with those done by pediatric surgeons. The chi2 test was used for nominal data and the Student's t test was used for continuous variables. Probabilities were calculated based on a logistic regression model.
  
  
  RESULTS
  Of 20,545 eligible hernia repairs, 50.3% were performed by pediatric surgeons and 49.7% were performed by general surgeons. Pediatric surgeons operated on 62.4% of children younger than 2 years, 51.8% of children aged 26 years, and 37% of children older than 7 years. Duration of operation, length of hospital stay, and incidence of early postoperative complications were similar among pediatric and general surgeons. The rate of recurrent inguinal hernia was higher in the general surgeon group compared with pediatric surgeons (1.10% vs 0.45%, P < .001). Among pediatric surgeons, the estimated risk of hernia recurrence was independent of surgical volume. There was a significant inverse correlation between surgeon volume and recurrence risk among general surgeons, with the highest volume general surgeons achieving recurrence rates similar to pediatric surgeons.
  
  
  CONCLUSIONS
  Pediatric surgeons have a lower rate of recurrence after inguinal hernia repair in children. General surgeons with high volumes have similar outcomes to pediatric surgeons.
authors.affiliation: Department of Surgery, Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Borenstein
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.forename: Anne
authors.initials: A
authors.lastname: Wajja
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Langer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D010372:Pediatrics / Q000193:education*; D011183:Postoperative Complications / Q000453:epidemiology*; D012008:Recurrence; D013043:Specialties, Surgical / Q000193:education*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*