OBJECTIVES: We examined the influence of surgeon age and other factors on proficiency in laparoscopic or open hernia repair. SUMMARY BACKGROUND DATA: 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 CSP456 (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. CONCLUSION: 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.
RCT Entities:
OBJECTIVES: We examined the influence of surgeon age and other factors on proficiency in laparoscopic or open hernia repair. SUMMARY BACKGROUND DATA: 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. CONCLUSION: 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: Kyle R Wanzel; Stanley J Hamstra; Marco F Caminiti; Dimitri J Anastakis; Ethan D Grober; Richard K Reznick Journal: Surgery Date: 2003-11 Impact factor: 3.982
Authors: Mark Wilkiemeyer; Theodore N Pappas; Anita Giobbie-Hurder; Kamal M F Itani; Olga Jonasson; Leigh A Neumayer Journal: Ann Surg Date: 2005-06 Impact factor: 12.969
Authors: Leigh Neumayer; Anita Giobbie-Hurder; Olga Jonasson; Robert Fitzgibbons; Dorothy Dunlop; James Gibbs; Domenic Reda; William Henderson Journal: N Engl J Med Date: 2004-04-25 Impact factor: 91.245
Authors: Leigh Neumayer; Olga Jonasson; Robert Fitzgibbons; William Henderson; James Gibbs; C James Carrico; Kamal Itani; Lawrence Kim; Theodore Pappas; Domenic Reda; Dorothy Dunlop; Martin McCarthy; Denise Hynes; Anita Giobbie-Hurder; Martin J London; Stephanie Hatton-Ward Journal: J Am Coll Surg Date: 2003-05 Impact factor: 6.113
Authors: John D Birkmeyer; Therese A Stukel; Andrea E Siewers; Philip P Goodney; David E Wennberg; F Lee Lucas Journal: N Engl J Med Date: 2003-11-27 Impact factor: 91.245
Authors: Brett R Anderson; Amelia S Wallace; Kevin D Hill; Brian C Gulack; Roland Matsouaka; Jeffrey P Jacobs; Emile A Bacha; Sherry A Glied; Marshall L Jacobs Journal: Circ Cardiovasc Qual Outcomes Date: 2017-07
Authors: Kinga Powers; Scott T Rehrig; Steven D Schwaitzberg; Mark P Callery; Daniel B Jones Journal: J Gastrointest Surg Date: 2009-02-04 Impact factor: 3.452