Volume of procedures and risk of recurrence after repair of groin hernia: national register study

doi:10.1136/bmj.39525.514572.25

BMJ 2008;336:934-937 (26 April), doi:10.1136/bmj.39525.514572.25 (published 21 April 2008)

Research

Volume of procedures and risk of recurrence after repair of groin hernia: national register study

Pär Nordin, senior consultant, head of the Swedish Hernia Register , Willem van der Linden, professor emeritus

¹ Department of Surgery, Östersund Hospital, S 83183, Östersund, Sweden

Correspondence to: P Nordin par.nordin{at}jll.se

Objective To determine whether the association between volumeand outcome found in major surgery also holds true for a minoroperation.

Design Review of outcomes after hernia surgery in Sweden.

Setting Surgical units registered with the Swedish hernia register,which in 2004 covered about 95% of all hernia operations inSweden.

Participants 86 409 patients over 15 years, who underwent 96601 unilateral or bilateral groin hernia repairs (94 077 inguinaland 2524 femoral) in 1996-2004 at the participating surgicalunits.

Main outcome measure Re-operation for recurrence.

Results There was a significantly higher rate of re-operationin surgeons who carried out 1-5 repairs a year than in surgeonswho carried out more repairs. There was no association betweenoutcome and further increases in volume. Although about halfof surgeons in Sweden who repair hernias are low volume operators,they performed only 8.4% of all repairs.

Conclusions Sweden’s numerous low volume hernia surgeonsperform such a small proportion of all operations that the impactof their inferior results on the nationwide re-operation rateis minimal. Volume indicates an approximate minimum value forthe number of hernia repairs a surgeon should do each year butthe outcome in surgeons who carry out more than that numberdisqualifies volume as an indicator of proficiency.

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Outcomes other than recurrence should be analysed: Martin Kurzer, Alan E Kark, and Tahir Hussain
BMJ 2008 336: 1033. [Extract] [Full Text] [PDF]

How to improve surgical outcomes: Peter J E Holt, Jan D Poloniecki, and Matt M Thompson
BMJ 2008 336: 900-901. [Extract] [Full Text] [PDF]

Need for expertise based randomised controlled trials: P J Devereaux, Mohit Bhandari, Mike Clarke, Victor M Montori, Deborah J Cook, Salim Yusuf, David L Sackett, Claudio S Cinà, S D Walter, Brian Haynes, Holger J Schünemann, Geoffrey R Norman, and Gordon H Guyatt
BMJ 2005 330: 88. [Extract] [Full Text] [PDF]

The surgeon as a risk factor: David Carter
BMJ 2003 326: 832-833. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Kurzer, M., Kark, A. E, Hussain, T. (2008). Outcomes other than recurrence should be analysed. BMJ 336: 1033-1033 [Full text]
Holt, P. J E, Poloniecki, J. D, Thompson, M. M (2008). How to improve surgical outcomes. BMJ 336: 900-901 [Full text]

Rapid Responses:

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Analyse the relevant outcome?: Martin Kurzer, et al.
bmj.com, 29 Apr 2008 [Full text]
Type of repair may be important in volume of surgery vs. outcome: Sudhir Kumar
bmj.com, 2 May 2008 [Full text]
An indisputable dichotomous endpoint is required: P�r Nordin, et al.
bmj.com, 4 May 2008 [Full text]
Type of repair in V/O studies of hernia surgery: P�r Nordin, et al.
bmj.com, 12 May 2008 [Full text]
The impact of Inferior results by patient age: Grazyna T Adamiak
bmj.com, 5 Jun 2008 [Full text]