The focus of our research has always been the improvement in patient outcomes. Our surgeons conduct large-scale surgical outcomes research that help identify predictors of success and higher quality of life for our patients. Our research has been presented at scientific meetings of the following surgical organizations:
- Americas Hernia Society (formerly, American Hernia Society)
- American Society of Plastic Surgeons
- American College of Surgeons
- Society of American Gastrointestinal and Endoscopic Surgeons
Our Center for Surgical Innovation also allows our surgeons to develop new medical devices that help improve the technical aspects of surgery.
It Matters: Surgeon Volume in Ventral Hernia Repair in New York State
Note: This study, presented at the International Hernia Congress held in Miami in March 2018, is an example of the large-scale surgical outcomes research that our surgeons do.
Background: The recent rise of hernia surgery as a subspecialty within general surgery has fueled the development and adoption of new open and minimally-invasive techniques. Another effect of this rise is the creation of high-volume ‘‘hernia centers’’ at many academic centers nationwide, which promise improved outcomes via higher volume and experience. This study examines the effect of surgeon volume on outcomes in open and laparoscopic ventral hernia repair.
Methods: A retrospective review using the New York State longitudinal hospital claims database (SPARCS). We examined patients aged ≥18 years who underwent ventral repair, as well as collected claims information for individual surgeons performing ventral hernia repair. Association between surgeon volume and clinical outcomes were assessed using generalized linear mixed model for readmission, recurrent hernia, infection, bleeding and linear mixed model for length of stay.
Results: There were 4,210 surgeons included in the analysis. Based on the distribution of surgeon volumes, the definition of laparoscopic volumes was: low (<5/year), medium (5–15), and high (>15). Open hernia volumes were: low (<10), medium (10–19), and high (>19). Univariate analysis showed that patients operated on by low-volume surgeons for both open and laparoscopic cases had highest 30-day readmission, recurrent hernia, infection, bleeding, and length of stay. In multivariable regression analysis, higher-volume laparoscopic surgeons had significantly lower risk of 30-day readmission or recurrent hernia compared to low-volume surgeons. High-volume open surgeons had significantly shorter length of stay, lower readmission, but higher risk of recurrent hernia than low-volume surgeons.
Conclusion: Laparoscopic ventral hernia surgery by high-volume surgeons is associated with lower surgical site infection, hospital resource utilization and long-term recurrence. The effect of volume on open hernia repair outcomes is less clear, likely as a result of individual procedural and patient complexity, not captured in the dataset.