title: Surgeon volume plays a significant role in outcomes and cost following open incisional hernia repair.
abstract: BACKGROUND
  Surgeon Volume Plays a Significant Role in Outcomes and Cost Following Open Incisional Hernia Repair
  
  
  OBJECTIVE
  Incisional hernia is a common complication following gastrointestinal surgery. Many surgeons elect to perform incisional hernia repairs despite performing only limited numbers of hernia repairs annually. This study examines the relationship between surgeon/facility volume and operative time, reoperation rates, and cost following initial open hernia repair.
  
  
  METHODS
  The New York Statewide Planning and Research Cooperative System was queried for elective open initial incisional hernias repairs from 2001 to 2006. Surgeon/facility volumes were calculated as mean number of open incisional hernia repairs per year from 2001 to 2006. Reoperations for recurrent hernia over a 5-year period were identified using ICD-9/CPT codes. Multivariable regression was used to compare patient, surgeon, and facility characteristics with operative time, hernia reoperation, and hospital charges.
  
  
  RESULTS
  Eighteen thousand forty-seven patients met the inclusion criteria. The hernia reoperation rate was 9%, and median time to reoperation was 1.4 years (mean = 1.8). After adjusting for clinical factors, surgeons performing an average of ≥36 repairs/year had significantly lower reoperation rates (HR = 0.59, 95% confidence interval (CI) = 0.48,0.72), operative time (incidence rate ratio (IRR) = 0.67, 95% CI = 0.64,0.71), and downstream charges (IRR = 0.63, 95% CI = 0.57,0.69). Facility characteristics (volume, academic affiliation, location) were not associated with reoperation.
  
  
  CONCLUSIONS
  This study found a strong association between individual surgeon incisional hernia repair volume and hernia reoperation rates, operative efficiency, and charges. Preferential referral to high-volume surgeons may lead to improved outcomes and lower costs.
authors.affiliation: Department of Surgery, Surgical Health Outcomes and Research Enterprise (S.H.O.R.E.), University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY, 14642, USA, christopher_aquina@urmc.rochester.edu.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Aquina
authors.forename: Kristin N
authors.initials: KN
authors.lastname: Kelly
authors.forename: Christian P
authors.initials: CP
authors.lastname: Probst
authors.forename: James C
authors.initials: JC
authors.lastname: Iannuzzi
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.forename: Howard N
authors.initials: HN
authors.lastname: Langstein
authors.forename: John R T
authors.initials: JR
authors.lastname: Monson
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
mesh_terms: D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs; D006555:Hernia, Ventral / Q000191:economics / Q000601:surgery*; D059685:Herniorrhaphy / Q000191:economics*; D017722:Hospital Charges; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome