title: Annual Surgeon Volume and Patient Outcomes Following Laparoscopic Totally Extraperitoneal Inguinal Hernia Repairs.
abstract: OBJECTIVE
  Data on laparoscopic totally extraperitoneal inguinal hernia repairs (TEP-IHRs) suggest that approximately 250 operations are needed to gain mastery, but the annual volume required to maintain high-quality outcomes is unknown.
  
  
  METHODS
  A retrospective review was performed of every patient undergoing a TEP-IHR at the Mayo Clinic (Rochester, MN) from 1995 to 2011. Analysis focused on the annual volume of 21 staff surgeons and their specific patient outcomes broken up into three groups: Group 1 (G1) (n = 1 surgeon) performed >30 repairs per year; Group 2 (G2) (n = 3 surgeons), 15-30 repairs; and Group 3 (G3) (n = 17), <15 repairs.
  
  
  RESULTS
  In total, 1601 patients underwent 2410 TEP-IHRs, with no significant patient demographic differences among groups. Greater annual surgeon volume (G1 > G2 > G3) was associated with improved outcomes as shown by the respective rates for intra- (1%, 2.6%, and 5.6%) and postoperative (13%, 27%, and 36%) complications, need for overnight stay (17%, 23%, and 29%), and hernia recurrence (1%, 4%, and 4.3%) (all P < .05). Surgeons with greater annual operative volumes were more likely to operate on patients with bilateral and recurrent hernias. Surgeons performing at least 15 repairs per year (G1 and G2) showed improvements in quality metrics over time.
  
  
  CONCLUSIONS
  Annual operative volumes of >30 repairs per year are associated with the highest quality outcomes for TEP-IHR. Operative volumes of at least 15 repairs per year are associated with improvements in quality metrics over time. Mentorship and operative assistance of low-volume TEP-IHR surgeons may be useful in improving patient outcomes.
authors: Department of Surgery, Mayo Clinic College of Medicine , Rochester, Minnesota.
authors: Yazan N
authors: YN
authors: AlJamal
authors: Department of Surgery, Mayo Clinic College of Medicine , Rochester, Minnesota.
authors: Benjamin
authors: B
authors: Zendejas
authors: Department of Surgery, Mayo Clinic College of Medicine , Rochester, Minnesota.
authors: Becca L
authors: BL
authors: Gas
authors: Department of Surgery, Mayo Clinic College of Medicine , Rochester, Minnesota.
authors: Shahzad M
authors: SM
authors: Ali
authors: Department of Surgery, Mayo Clinic College of Medicine , Rochester, Minnesota.
authors: Stephanie F
authors: SF
authors: Heller
authors: Department of Surgery, Mayo Clinic College of Medicine , Rochester, Minnesota.
authors: Michael L
authors: ML
authors: Kendrick
authors: Department of Surgery, Mayo Clinic College of Medicine , Rochester, Minnesota.
authors: David R
authors: DR
authors: Farley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D066231:Surgeons / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult