腹壁再建術における術者の年齢と経験が合併症に及ぼす影響

VHR is one of the most performed operations in the United States. The influence of surgeon age and experience on postoperative outcomes following VHR remains unclear. Our study aims to evaluate the effect of surgeons' age and experience on complications following open, laparoscopic, and robotic-assisted ventral hernia repairs (VHR).

A retrospective analysis of the Abdominal Core Health Quality Collaborative (ACHQC) database identified patients undergoing open, laparoscopic, or robotic VHR. Surgeons were categorized by age (30-39, 40-49, 50-59 and ≥ 60 years old) and experience. Experience was defined using estimated lifetime case volume.

In open repairs, increasing age was associated with significantly higher odds of recurrence but lower odds of SSO. Experienced surgeons had higher odds recurrence (OR 7.1, p < 0.001), but lower odds SSO (OR 0.5, p < 0.001) and reoperation (OR 0.8, p = 0.001). In robotic repairs, increasing age was associated with significantly higher odds of recurrence and reoperation but lower odds of SSO. Experience was protective for recurrence (OR 0.7), SSO (OR 0.07), and reoperation rates (OR 0.006) (all p < 0.001). In laparoscopic repairs, age was not associated with odds of recurrence, SSO, or reoperation. Experienced surgeons had higher odds of recurrence (OR 3.5, p < 0.001) but lower odds of reoperation (OR 0.2, p < 0.001).

In open repairs, both age and experience were associated with lower odds of SSO; however, experience was associated with higher recurrence. Older surgeons had higher odds of recurrence in robotic repairs, whereas experience was protective. These findings suggest that targeted training and credentialing strategies that account for both age and procedural familiarity may help optimize patient outcomes across all hernia repair techniques.