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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Effect of subspecialty training and volume on outcome after pediatric inguinal hernia repair
Steven H Borenstein1, Teresa To, Anne Wajja
1Department of Surgery, Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada.
Insights
Pediatric surgeons have lower recurrence rates for pediatric inguinal hernia repair. High-volume general surgeons achieve similar outcomes, indicating surgical experience is key for better results.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
Background:
- Inguinal hernia repair is a common pediatric surgical procedure.
- Variations in surgical training and specialization exist among surgeons performing this operation.
Purpose of the Study:
- To compare the outcomes of pediatric inguinal hernia repair performed by pediatric surgeons versus general surgeons.
- To identify factors influencing recurrence rates in pediatric inguinal hernia repair.
Main Methods:
- Population-based review of 20,545 pediatric inguinal hernia repairs in Ontario (1993-2000).
- Exclusion of children with complex medical conditions or prematurity.
- Statistical comparison using chi-squared and Student's t-tests, with logistic regression for probability.
Main Results:
- No significant differences in operation duration, hospital stay, or early complications between surgeon groups.
- Recurrence rate was higher for general surgeons (1.10%) compared to pediatric surgeons (0.45%).
- High surgical volume correlated with lower recurrence rates among general surgeons, achieving outcomes similar to pediatric surgeons.
Conclusions:
- Pediatric surgeons demonstrate lower recurrence rates in pediatric inguinal hernia repair.
- High-volume general surgeons achieve comparable outcomes to pediatric surgeons, highlighting the importance of surgical experience.
Background/Purpose:
Inguinal hernia repair is the most common operation performed in children. The aim of this study was to determine if there are any differences in outcome when this procedure is performed by subspecialist pediatric surgeons when compared with general surgeons.
Methods:
All pediatric inguinal hernias repaired in the province of Ontario between 1993 and 2000 were reviewed using a population-based database. Children with complex medical conditions or prematurity were excluded. Cases done by general surgeons were compared with those done by pediatric surgeons. The chi2 test was used for nominal data and the Student's t test was used for continuous variables. Probabilities were calculated based on a logistic regression model.
Results:
Of 20,545 eligible hernia repairs, 50.3% were performed by pediatric surgeons and 49.7% were performed by general surgeons. Pediatric surgeons operated on 62.4% of children younger than 2 years, 51.8% of children aged 26 years, and 37% of children older than 7 years. Duration of operation, length of hospital stay, and incidence of early postoperative complications were similar among pediatric and general surgeons. The rate of recurrent inguinal hernia was higher in the general surgeon group compared with pediatric surgeons (1.10% vs 0.45%, P < .001). Among pediatric surgeons, the estimated risk of hernia recurrence was independent of surgical volume. There was a significant inverse correlation between surgeon volume and recurrence risk among general surgeons, with the highest volume general surgeons achieving recurrence rates similar to pediatric surgeons.
Conclusions:
Pediatric surgeons have a lower rate of recurrence after inguinal hernia repair in children. General surgeons with high volumes have similar outcomes to pediatric surgeons.
