Risk of Reoperation for Recurrence After Elective Primary Groin and Ventral Hernia Repair by Supervised Residents

Abstract

ImportanceSurgical training involves letting residents operate under supervision. Since hernia repair is a common procedure worldwide, it is a frequent part of the surgical curriculum.ObjectiveTo assess the risk of reoperation for recurrence after elective primary groin and ventral hernia repair performed by supervised residents compared with that by specialists.Design, Setting, and ParticipantsThis nationwide register-based cohort study included data from January 2016 to September 2021. Patients were followed up until reoperation, emigration, death, or the end of the study period. The study used data from the Danish Inguinal and Ventral Hernia Databases linked with data from the Danish Patient Safety Authority’s Online Register via surgeons’ unique authorization ID.The cohort included patients aged 18 years or older who underwent primary elective hernia repairs performed by supervised residents or specialists for inguinal, femoral, epigastric, or umbilical hernias. Hernia repairs were divided into the following 4 groups: Lichtenstein groin, laparoscopic transabdominal preperitoneal (TAPP) groin, open ventral, and laparoscopic ventral.ExposuresHernia repairs performed by supervised residents vs specialists.Main Outcomes and MeasuresReoperation for recurrence, analyzed separately for all 4 groups.ResultsA total of 868 specialists and residents who performed 31 683 primary groin and 7777 primary ventral hernia repairs were included in this study. The median age of patients who underwent hernia repair was 60 years (IQR, 48-70 years), and 33 424 patients (84.7%) were male. There was no significant difference in the adjusted risk of reoperation after Lichtenstein groin hernia repair (hazard ratio [HR], 1.26; 95% CI, 0.99-1.59), laparoscopic groin hernia repair (HR, 1.01; 95% CI, 0.73-1.40), open ventral hernia repair (HR, 0.89; 95% CI, 0.61-1.29), and laparoscopic ventral hernia repair (HR, 2.96; 95% CI, 0.99-8.84) performed by supervised residents compared with those by specialists. There was, however, a slightly increased unadjusted, cumulative reoperation rate after Lichtenstein repairs performed by supervised residents compared with those by specialists (4.8% vs 4.2%; P = .048).Conclusions and RelevanceThe findings of this study suggest that neither open nor laparoscopic repair of groin and ventral hernias performed by supervised residents appeared to be associated with a higher risk of reoperation for recurrence compared with the operations performed by specialists. This indicates that residents may safely perform elective hernia repair when supervised as part of their training curriculum.

Learning curve in open groin hernia surgery: nationwide register-based study

“…A recent study from the Danish Hernia Register found no significant difference in reoperation risk for recurrent groin hernia between supervised residents and specialists 23 . In a report from the Swedish Hernia Register, it was found that male patients are at greater risk of reoperation on for recurrent groin hernia when a surgical trainee exceeded a certain operation time, emphasizing the importance of structured supervision 24 .…”

Patient Surgical Outcomes When Surgery Residents Are the Primary Surgeon by Intensity of Surgical Attending Supervision in Veterans Affairs Medical Centers

“…Some caution in applying these findings to GME policy is advised in light of the growing concerns that graduates may be leaving residency programs unprepared to enter independent practice. 6 – 23 , 25 One approach is to change how residents are supervised to promote greater contacts with surgical attendings while maintaining the resident’s increasing autonomy during the procedure. 7 On the other hand, a separate study using electronic health records of VA medical centers between 2004 and 2019 showed clinical productivity of surgery residents net of supervision had increased over time consistent with a progressive independence hypothesis.…”

“… 1 – 3 To address this question, academic leaders often cite studies reporting patients receive better medical 11 , 12 and surgical care 13 , 14 in teaching than nonteaching clinical settings. Surgery encounters involving a scrubbed resident have been found to have no worse outcome than those that either did not involve a resident or the resident was not scrubbed with respect to mortality, 8 , 9 , 15 – 18 complications, 8 , 9 , 15 , 19 – 22 readmissions and reoperations, 15 , 17 – 19 , 23 patient satisfaction, 21 or pain scores. 22 …”

Supervision and Transparency in Resident Training

“…In "Risk of Reoperation for Recurrence After Elective Primary Groin and Ventral Hernia Repair by Supervised Residents," Christophersen et al demonstrate that involvement of surgical residents in primary hernia repairs had no significant impact on reoperation rates. 1 Because of the addition of supervision as a recorded variable in the Danish database, the authors were able to pair surgical outcomes with the dichotomous (presence or absence) value of supervision. Complexity was recorded based on several patient or operative characteristics.…”