title: Proficiency of surgeons in inguinal hernia repair: effect of experience and age.
abstract: OBJECTIVE
  We examined the influence of surgeon age and other factors on proficiency in laparoscopic or open hernia repair.
  
  
  BACKGROUND
  In a multicenter, randomized trial comparing open and laparoscopic herniorrhaphies, conducted in Veterans Administration hospitals (CSP 456), we reported significant differences in recurrence rates (RR) for the laparoscopic procedure as a result of surgeons' experience. We have also reported significant differences in RR for the open procedure related to resident postgraduate year (PGY) level.
  
  
  METHODS
  We analyzed data from unilateral laparoscopic and open herniorrhaphies from CSP 456 (n = 1629). Surgeon's experience (experienced > or =250 procedures; inexperienced <250), surgeon's age, median PGY level of the participating resident, operation time, and hospital observed-to-expected (O/E) ratios for mortality were potential independent predictors of RR.
  
  
  RESULTS
  Age was dichotomized into older (> or =45 years) and younger (<45 years). Surgeon's inexperience and older age were significant predictors of recurrence in laparoscopic herniorrhaphy. The odds of recurrence for an inexperienced surgeon aged 45 years or older was 1.72 times that of a younger inexperienced surgeon. For open repairs, although surgeon's age and operation time appeared to be related to recurrence, only median PGY level of <3 was a significant independent predictor.
  
  
  CONCLUSIONS
  This analysis demonstrates that surgeon's age of 45 years and older, when combined with inexperience in laparoscopic inguinal herniorrhaphies, increases risk of recurrence. For open repairs, only a median PGY level of <3 was a significant risk factor.
authors.affiliation: VA Salt Lake City Health Care System, University of Utah Health Sciences Center, Salt Lake City, UT 84148, USA. leigh.neumayer@hsc.utah.edu
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Neumayer
authors.forename: Atul A
authors.initials: AA
authors.lastname: Gawande
authors.forename: Jia
authors.initials: J
authors.lastname: Wang
authors.forename: Anita
authors.initials: A
authors.lastname: Giobbie-Hurder
authors.forename: Kamal M F
authors.initials: KM
authors.lastname: Itani
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fitzgibbons
authors.forename: Domenic
authors.initials: D
authors.lastname: Reda
authors.forename: Olga
authors.initials: O
authors.lastname: Jonasson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D012008:Recurrence; D013514:Surgical Procedures, Operative / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States