72118 - Surgical Unit Volume and Reoperation for Recurrence Following Total Extra-Peritoneal Groin Hernia Repairs: Nationwide Population-based Register Study Article Swipe

Introduction The quality of total extra-peritoneal groin hernia repair (TEP-GHR) and recurrence rates are influenced by various factors, potentially including the annual volume of repairs conducted by surgical units. The precise nature of this relationship remains unclear. This study aimed to investigate the surgical unit volume influence on reoperation rates for recurrence following TEP-GHR. Method This observational nationwide population-based study utilized prospectively collected data from the Swedish Hernia Register. Patient ≥15 years old who underwent a TEP-GHR between 2015 and 2019 were eligible. Follow-up time was minimum 3 years after surgery. Surgical units were grouped into; low-volume (<12 repairs/year), low-medium volume (12-50 repairs/year), medium-high volume (>50-150 repairs/year) and high-volume (>150 repairs/year) units. Primary outcome was reoperation for recurrence. Secondary outcome was postoperative complications within 30 days. Result 20,656 elective TEP-GHR’s were included across 75 surgical units. The reoperation rate for recurrence was higher in all three lower-volume groups; low-volume (5.3%), low-medium (3.8%) and medium-high (3.5%) compared to the high-volume group (2.9%). Adjusted multivariate cox regression analysis revealed a statistically significant increased hazard ratio for reoperation for recurrence in the low-volume group: 1.87 (95% CI 1.31-2.67) and in the low-medium volume group; 1.32 (95% CI 1.07-1.62) compared to the high-volume group. No difference was seen between the groups regarding the risk of postoperative complications. Discussion The risk of reoperation for recurrence following TEP-GHR was significantly increased in surgical units with less than 50 repairs performed per year. These findings may influence guidelines on required annual surgical unit volume to improve patient outcomes following TEP-GHR.