Department of Plastic and Reconstructive Surgery, Unit 1488, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA.
Hernia. 2023 Jun;27(3):583-592. doi: 10.1007/s10029-022-02731-6. Epub 2022 Dec 27.
While many factors have been correlated with lesser outcomes in abdominal wall reconstruction (AWR), the impact of surgeon experience has yet to be elucidated. We sought to evaluate the effect of cumulative surgeon experience on long-term complex AWR outcomes.
We conducted a comprehensive review of all consecutive patients who underwent AWR using biologic mesh for the repair of ventral hernias or tumor resection defects from March 2005 to June 2019. The primary outcome measure was hernia recurrence (HR). Secondary outcomes were surgical site occurrences (SSOs) and surgical site infections (SSIs). Patients were a priori categorized into the following groups according to the cumulative number of hernia repairs performed by their surgeons: low (< 50), moderate experience (50-100), and high (> 100) experience.
We identified 60 surgeons and 650 consecutive patients (62% women) who met our inclusion criteria. In adjusted models, AWR performed by surgeons with high experience was associated with a fourfold lower risk of HR (hazard ratio, 0.28; 95% confidence interval, 0.08 to 0.87), but the odds of surgical site occurrences (odds ratio, 0.72, 95% confidence interval, 0.34 to 1.52) and surgical site infections (odds ratio, 0.89, 95% confidence interval, 0.26 to 2.86) did not differ significantly in the high-experience group.
High surgical experience, defined as > 100 cumulative hernia repairs, is predictive for markedly lower HR rates in complex AWR. These findings have potential implications for preoperative risk assessment, patient-centered surgeon selection, regulatory oversight, specific referral patterns, designations of centers of excellence, and individual provider or trainee quality improvement.
尽管许多因素与腹壁重建（AWR）的较差结果相关，但外科医生经验的影响尚未阐明。我们旨在评估累积外科医生经验对长期复杂 AWR 结果的影响。
我们对 2005 年 3 月至 2019 年 6 月期间使用生物网片修复腹疝或肿瘤切除缺损的所有连续 AWR 患者进行了全面回顾。主要结局测量指标是疝复发（HR）。次要结局是手术部位事件（SSO）和手术部位感染（SSI）。根据他们的外科医生进行的疝修复总数，患者被预先分为以下三组：低经验组（<50 例）、中经验组（50-100 例）和高经验组（>100 例）。
我们确定了 60 名外科医生和 650 名符合纳入标准的连续患者（62%为女性）。在调整模型中，高经验外科医生进行的 AWR 与 HR 的风险降低四倍相关（风险比，0.28；95%置信区间，0.08 至 0.87），但手术部位事件的可能性（优势比，0.72，95%置信区间，0.34 至 1.52）和手术部位感染（优势比，0.89，95%置信区间，0.26 至 2.86）在高经验组中没有显著差异。
高手术经验，定义为>100 例累积疝修复，与复杂 AWR 中 HR 率显著降低相关。这些发现可能对术前风险评估、以患者为中心的外科医生选择、监管监督、特定转诊模式、卓越中心的指定以及个别提供者或学员质量改进具有潜在影响。
