title: Does surgeon frustration and satisfaction with the operation predict outcomes of open or laparoscopic inguinal hernia repair?
abstract: BACKGROUND
  A surgeon's level of frustration when performing an operation and level of satisfaction at completion may be correlated with patients' outcomes. We evaluated the relationship between the attending surgeons' frustration and satisfaction and recurrence and complications of open and laparoscopic inguinal hernia repair.
  
  
  METHODS
  Men with detectable inguinal hernias were randomized to undergo open or laparoscopic herniorrhaphy at 14 Veterans Affairs hospitals. After completion of the procedure, surgeons were asked to assess their level of frustration during the operation and their overall satisfaction with the operative result. Two subjective scales ranging from 1 (not frustrated/not satisfied) to 5 (very frustrated/very satisfied) were used to independently assess both parameters. Reasons for surgeon frustration were evaluated. Patients were followed for 2 years for recurrence and complications.
  
  
  RESULTS
  Of 1,983 patients who underwent hernia repair, 1,622 were available for analysis; 808 had open repair and 813 had laparoscopic repair. Surgeons reported less frustration and more satisfaction with open than with laparoscopic repair (p = 0.0001 and 0.0001, respectively). Frustration was associated with a higher rate of hernia recurrence at 2 years (adjusted odds ratio, 2.01, 95% CI, 1.15-3.51) in open repair, and a higher overall rate of postoperative complications (adjusted odds ratio, 1.27, 95% CI, 1.03-1.56) in both open and laparoscopic hernia repair. Satisfaction was not correlated with recurrence or complications.
  
  
  CONCLUSIONS
  The level of a surgeon's frustration during performance of an inguinal herniorrhaphy was a better predictor of outcomes of the operation than was satisfaction with the procedure. Sources of intraoperative frustration should be controlled to improve outcomes.
authors.affiliation: Michael E DeBakey Veterans Affairs Medical Center and Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Haytham M A
authors.initials: HM
authors.lastname: Kaafarani
authors.forename: Kamal M F
authors.initials: KM
authors.lastname: Itani
authors.forename: Anita
authors.initials: A
authors.lastname: Giobbie-Hurder
authors.forename: John J
authors.initials: JJ
authors.lastname: Gleysteen
authors.forename: Martin
authors.initials: M
authors.lastname: McCarthy
authors.forename: James
authors.initials: J
authors.lastname: Gibbs
authors.forename: Leigh
authors.initials: L
authors.lastname: Neumayer
mesh_terms: D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D010549:Personal Satisfaction; D010820:Physicians / Q000523:psychology*; D011183:Postoperative Complications / Q000453:epidemiology; D014728:Veterans