O. Renteria1,2, A. A. Mokdad1, J. Imran1, S. Huerta1,2 1University Of Texas Southwestern Medical Center,Surgery,Dallas, TX, USA 2VA North Texas Health Care System,General Surgery,Dallas, TX, USA
Introduction:
Previous studies have demonstrated that the postgraduate year (PGY) resident level does not influence outcomes for complex vaginal surgery, carotid endarterectomy, pancreatic surgery and upper gastro-intestinal surgery. For inguinal hernias (IH), data indicate that PGY-3 residents have lower rate of recurrence compared with PGY-1 and 2 after the repair of an open inguinal herniorrhaphy. Lower PGY level was also associated with increased operative time for both open and laparoscopic hernia repair. We hypothesize that when controlling for surgeon, technique, and hernia type, the outcomes for inguinal herniorrhaphy are the same independent of PGY level.
Methods:
This is a retrospective review of only unilateral IH performed by the same surgeon between 2005-2015 at the VA North Texas Health Care System. Bilateral, recurrent IH, laparoscopic IH, femoral and IH repair simultaneously with an umbilical hernia were excluded from the analysis (n=170). Patient demographic and clinical information, perioperative data, and resident level involvement were compared between patients that had a postoperative morbidity and those that did not. Wilcoxon rank-sum test and Fisher’s exact test were used to compare the continuous and categorical outcomes, respectively. Patient postoperative morbidity was explored in a multivariable logistic regression model. The model was constructed using a forward stepwise technique. Operative time was also examined using an ordinary least square linear regression model.
Results:
752 unilateral inguinal hernias were included in this study with the following characteristics: age (60.6±12.7 years-old), BMI (27.0±10.8 Kg/m2 ), (ASA III-IV = 51%) Nyhus classification (type 2: 44.7%, 3a 41.6%, 3b 12.6%, 3c 1.1%.). 17.2 % of the residents involved in the repairs were PGY-1, 71.1% PGY-2-3 and 11.7% PGY4-5. The overall complication rate was 7.8% and recurrence rate was 1.2% for this cohort. Postoperative complications for intern, junior, and senior residents, were 4%, 9%, and 6%, respectively (p=0.14). Compared to interns, junior residents (PGY level 2-3) finished the operation 3.9 minutes faster (95% CI = -7.5 to -0.3), but there was no difference between interns and senior residents completing the operations after controlling for Nyhus hernia type. Logistic regression did not identify PGY-level as an independent predictor of complications.
Conclusion:
Overall, there was a slight decrease in operative time when the repair was done with junior level residents however PGY level does not influence outcomes for open, unilateral inguinal herniorrhaphy.