title: Does resident post graduate year influence the outcomes of inguinal hernia repair?
abstract: BACKGROUND
  We evaluated the effect of the postgraduate medical education level (PGY) of surgery residents on recurrence of inguinal hernia, complications, and operative time.
  
  
  METHODS
  Post hoc analysis was performed on prospectively collected data from a multicenter Veterans Affairs (VA) cooperative study. Men were randomly assigned to open or laparoscopic inguinal hernia repairs with mesh. Surgery residents performed repairs with designated attending surgeons present throughout all procedures. PGY level of the resident was recorded for each procedure. All patients were followed for 2 years for hernia recurrence and complications. PGY levels were grouped as follows: group I = PGY 1 and 2; group II = PGY 3; group III = PGY >/= 4; rates of recurrence, complications and mean operative time were compared.
  
  
  RESULTS
  A total of 1983 patients underwent hernia repair. group III residents had significantly lower recurrence rates for open repairs when compared with group I (adjusted odds ratio = 0.24, 95% confidence interval [CI], 0.06, 0.997). The recurrence rate was similar among the groups for laparoscopic repair (P > 0.05) Complication rates were not different for either repair (P > 0.05). Mean operative time was significantly shorter for group III compared with group I for both open (-6.6 minutes; 95% CI, -11.7, -1.5) and laparoscopic repairs (-12.9 minutes; 95% CI, -19.8, -6.0) and between group II and group I for laparoscopic repair (-15.0; 95% CI, -24.3, -5.7).
  
  
  CONCLUSIONS
  Despite the presence of an attending surgeon, open hernia repairs performed by junior residents were associated with higher recurrence rates than those repaired by senior residents. Lower resident level was associated with increased operative time for both open and laparoscopic repair.
authors.affiliation: Duke University, Durham, North Carolina, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Wilkiemeyer
authors.forename: Theodore N
authors.initials: TN
authors.lastname: Pappas
authors.forename: Anita
authors.initials: A
authors.lastname: Giobbie-Hurder
authors.forename: Kamal M F
authors.initials: KM
authors.lastname: Itani
authors.forename: Olga
authors.initials: O
authors.lastname: Jonasson
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Neumayer
mesh_terms: D002983:Clinical Competence; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D016896:Treatment Outcome