title: Laparoscopic Repair of Primary Inguinal Hernia Performed in Public Hospitals or Low-Volume Centers Have Increased Risk of Reoperation for Recurrence.
abstract: BACKGROUND
  Inguinal hernia repair is traditionally carried out as either open or laparoscopic repair. Laparoscopic repair has been shown to be superior in terms of pain and discomfort, but has a higher risk of reoperation. Quality of inguinal hernia repair is related to factors such as method of repair, characteristics of patients, and possibly the annual volume of procedures performed by a center. The aim of this study was to test the hypothesis that hospital volume and type of hospital (private vs public) could influence the reoperation rate for recurrence as a marker of surgical quality of care.
  
  
  METHODS
  This study was based on data from the Danish Hernia Database covering the period from January 1, 1998, to December 31, 2013. Hernia repairs included in this study were laparoscopic repair of primary, inguinal hernias in the elective setting, performed on adult male patients.
  
  
  RESULTS
  A total of 14 532 laparoscopic repairs were included for analysis. Centers reporting less than 50 procedures a year had a significantly higher cumulative reoperation rate compared with centers reporting more than 50 procedures a year (9.97% vs 6.06%), P < .0001. Private centers had a lower cumulative reoperation rate compared with public centers: 5.36% versus 8.53%, P ≤ .0001. Type of center and center volume were both independent risk factors for reoperation in a Cox regression model.
  
  
  CONCLUSIONS
  Hospital volume had an effect on the reoperation rate for recurrence after laparoscopic inguinal hernia repair. Furthermore, private centers performed better than public centers irrespective of volume.
authors.affiliation: Herlev Hospital, University of Copenhagen, Herlev, Denmark Danish Hernia Database, Copenhagen, Denmark kristofferandresen@gmail.com.
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Andresen
authors.affiliation: Danish Hernia Database, Copenhagen, Denmark Horsens Regional Hospital, Horsens, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Friis-Andersen
authors.affiliation: Herlev Hospital, University of Copenhagen, Herlev, Denmark Danish Hernia Database, Copenhagen, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006552:Hernia, Inguinal / Q000601:surgery*; D006779:Hospitals, Public; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: TAPP; cohort; database; inguinal hernia; laparoscopy; reoperation; surgical volume