Does resident post graduate year influence the outcomes of inguinal hernia repair?

Mark Wilkiemeyer, Theodore N. Pappas, Anita Giobbie-Hurder, Kamal M.F. Itani, Olga Jonasson, Leigh A. Neumayer, Kenneth G. MacDonald, Bruce Ramshaw, J. Patrick O'Leary, James A. O'Neill, W. Robert Rout

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

Introduction: We evaluated the effect of the postgraduate medical education level (PGY) of surgery residents on recurrence of inguinal hernia, complications, and operative time. Methods: Post hoc analysis was performed on prospectively collected data from a multicenter Veterans Affairs (VA) cooperative study. Men were randomly assigned to open or laparoscopic inguinal hernia repairs with mesh. Surgery residents performed repairs with designated attending surgeons present throughout all procedures. PGY level of the resident was recorded for each procedure. All patients were followed for 2 years for hernia recurrence and complications. PGY levels were grouped as follows: group I = PGY 1 and 2; group II = PGY 3; group III = PGY ≥ 4; rates of recurrence, complications and mean operative time were compared. Results: A total of 1983 patients underwent hernia repair, group III residents had significantly lower recurrence rates for open repairs when compared with group I (adjusted odds ratio = 0.24, 95% confidence interval [CI], 0.06, 0.997). The recurrence rate was similar among the groups for laparoscopic repair (P > 0.05) Complication rates were not different for either repair (P > 0.05). Mean operative time was significantly shorter for group III compared with group I for both open (-6.6 minutes; 95% CI, -11.7, -1.5) and laparoscopic repairs (-12.9 minutes; 95% CI, -19.8, -6.0) and between group II and group I for laparoscopic repair (-15.0; 95% CI, -24.3, -5.7). Conclusions: Despite the presence of an attending surgeon, open hernia repairs performed by junior residents were associated with higher recurrence rates than those repaired by senior residents. Lower resident level was associated with increased operative time for both open and laparoscopic repair.

Original languageEnglish (US)
Pages (from-to)879-884
Number of pages6
JournalAnnals of surgery
Volume241
Issue number6
DOIs
StatePublished - Jun 1 2005
Externally publishedYes

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Inguinal Hernia
Herniorrhaphy
Operative Time
Recurrence
Confidence Intervals
Veterans
Hernia
Medical Education
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Wilkiemeyer, M., Pappas, T. N., Giobbie-Hurder, A., Itani, K. M. F., Jonasson, O., Neumayer, L. A., ... Rout, W. R. (2005). Does resident post graduate year influence the outcomes of inguinal hernia repair? Annals of surgery, 241(6), 879-884. https://doi.org/10.1097/01.sla.0000164076.82559.72

Does resident post graduate year influence the outcomes of inguinal hernia repair? / Wilkiemeyer, Mark; Pappas, Theodore N.; Giobbie-Hurder, Anita; Itani, Kamal M.F.; Jonasson, Olga; Neumayer, Leigh A.; MacDonald, Kenneth G.; Ramshaw, Bruce; O'Leary, J. Patrick; O'Neill, James A.; Rout, W. Robert.

In: Annals of surgery, Vol. 241, No. 6, 01.06.2005, p. 879-884.

Research output: Contribution to journalArticle

Wilkiemeyer, M, Pappas, TN, Giobbie-Hurder, A, Itani, KMF, Jonasson, O, Neumayer, LA, MacDonald, KG, Ramshaw, B, O'Leary, JP, O'Neill, JA & Rout, WR 2005, 'Does resident post graduate year influence the outcomes of inguinal hernia repair?', Annals of surgery, vol. 241, no. 6, pp. 879-884. https://doi.org/10.1097/01.sla.0000164076.82559.72
Wilkiemeyer M, Pappas TN, Giobbie-Hurder A, Itani KMF, Jonasson O, Neumayer LA et al. Does resident post graduate year influence the outcomes of inguinal hernia repair? Annals of surgery. 2005 Jun 1;241(6):879-884. https://doi.org/10.1097/01.sla.0000164076.82559.72
Wilkiemeyer, Mark ; Pappas, Theodore N. ; Giobbie-Hurder, Anita ; Itani, Kamal M.F. ; Jonasson, Olga ; Neumayer, Leigh A. ; MacDonald, Kenneth G. ; Ramshaw, Bruce ; O'Leary, J. Patrick ; O'Neill, James A. ; Rout, W. Robert. / Does resident post graduate year influence the outcomes of inguinal hernia repair?. In: Annals of surgery. 2005 ; Vol. 241, No. 6. pp. 879-884.
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abstract = "Introduction: We evaluated the effect of the postgraduate medical education level (PGY) of surgery residents on recurrence of inguinal hernia, complications, and operative time. Methods: Post hoc analysis was performed on prospectively collected data from a multicenter Veterans Affairs (VA) cooperative study. Men were randomly assigned to open or laparoscopic inguinal hernia repairs with mesh. Surgery residents performed repairs with designated attending surgeons present throughout all procedures. PGY level of the resident was recorded for each procedure. All patients were followed for 2 years for hernia recurrence and complications. PGY levels were grouped as follows: group I = PGY 1 and 2; group II = PGY 3; group III = PGY ≥ 4; rates of recurrence, complications and mean operative time were compared. Results: A total of 1983 patients underwent hernia repair, group III residents had significantly lower recurrence rates for open repairs when compared with group I (adjusted odds ratio = 0.24, 95{\%} confidence interval [CI], 0.06, 0.997). The recurrence rate was similar among the groups for laparoscopic repair (P > 0.05) Complication rates were not different for either repair (P > 0.05). Mean operative time was significantly shorter for group III compared with group I for both open (-6.6 minutes; 95{\%} CI, -11.7, -1.5) and laparoscopic repairs (-12.9 minutes; 95{\%} CI, -19.8, -6.0) and between group II and group I for laparoscopic repair (-15.0; 95{\%} CI, -24.3, -5.7). Conclusions: Despite the presence of an attending surgeon, open hernia repairs performed by junior residents were associated with higher recurrence rates than those repaired by senior residents. Lower resident level was associated with increased operative time for both open and laparoscopic repair.",
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AU - Wilkiemeyer, Mark

AU - Pappas, Theodore N.

AU - Giobbie-Hurder, Anita

AU - Itani, Kamal M.F.

AU - Jonasson, Olga

AU - Neumayer, Leigh A.

AU - MacDonald, Kenneth G.

AU - Ramshaw, Bruce

AU - O'Leary, J. Patrick

AU - O'Neill, James A.

AU - Rout, W. Robert

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N2 - Introduction: We evaluated the effect of the postgraduate medical education level (PGY) of surgery residents on recurrence of inguinal hernia, complications, and operative time. Methods: Post hoc analysis was performed on prospectively collected data from a multicenter Veterans Affairs (VA) cooperative study. Men were randomly assigned to open or laparoscopic inguinal hernia repairs with mesh. Surgery residents performed repairs with designated attending surgeons present throughout all procedures. PGY level of the resident was recorded for each procedure. All patients were followed for 2 years for hernia recurrence and complications. PGY levels were grouped as follows: group I = PGY 1 and 2; group II = PGY 3; group III = PGY ≥ 4; rates of recurrence, complications and mean operative time were compared. Results: A total of 1983 patients underwent hernia repair, group III residents had significantly lower recurrence rates for open repairs when compared with group I (adjusted odds ratio = 0.24, 95% confidence interval [CI], 0.06, 0.997). The recurrence rate was similar among the groups for laparoscopic repair (P > 0.05) Complication rates were not different for either repair (P > 0.05). Mean operative time was significantly shorter for group III compared with group I for both open (-6.6 minutes; 95% CI, -11.7, -1.5) and laparoscopic repairs (-12.9 minutes; 95% CI, -19.8, -6.0) and between group II and group I for laparoscopic repair (-15.0; 95% CI, -24.3, -5.7). Conclusions: Despite the presence of an attending surgeon, open hernia repairs performed by junior residents were associated with higher recurrence rates than those repaired by senior residents. Lower resident level was associated with increased operative time for both open and laparoscopic repair.

AB - Introduction: We evaluated the effect of the postgraduate medical education level (PGY) of surgery residents on recurrence of inguinal hernia, complications, and operative time. Methods: Post hoc analysis was performed on prospectively collected data from a multicenter Veterans Affairs (VA) cooperative study. Men were randomly assigned to open or laparoscopic inguinal hernia repairs with mesh. Surgery residents performed repairs with designated attending surgeons present throughout all procedures. PGY level of the resident was recorded for each procedure. All patients were followed for 2 years for hernia recurrence and complications. PGY levels were grouped as follows: group I = PGY 1 and 2; group II = PGY 3; group III = PGY ≥ 4; rates of recurrence, complications and mean operative time were compared. Results: A total of 1983 patients underwent hernia repair, group III residents had significantly lower recurrence rates for open repairs when compared with group I (adjusted odds ratio = 0.24, 95% confidence interval [CI], 0.06, 0.997). The recurrence rate was similar among the groups for laparoscopic repair (P > 0.05) Complication rates were not different for either repair (P > 0.05). Mean operative time was significantly shorter for group III compared with group I for both open (-6.6 minutes; 95% CI, -11.7, -1.5) and laparoscopic repairs (-12.9 minutes; 95% CI, -19.8, -6.0) and between group II and group I for laparoscopic repair (-15.0; 95% CI, -24.3, -5.7). Conclusions: Despite the presence of an attending surgeon, open hernia repairs performed by junior residents were associated with higher recurrence rates than those repaired by senior residents. Lower resident level was associated with increased operative time for both open and laparoscopic repair.

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