Surgical expertise and risk of long-term complications following groin hernia mesh repair in Sweden: a prospective, patient-reported, nationwide register study.

Abstract

<h4>Background</h4>Despite the global prevalence of groin hernia repairs, there is still limited understanding regarding the impact of surgical expertise on patient outcomes, particularly since a significant portion of hernia repairs worldwide are performed by junior surgeons. This study aims to evaluate the long-term outcomes of groin hernia repairs carried out by specialist compared to those performed by resident surgeons.<h4>Material and methods</h4>This observational, nationwide, population-based registry study utilized prospectively collected data from the Swedish Hernia Register as well as patient-reported outcome measures (PROM) 1 year after groin hernia surgery. Included patients were aged 15 years or older who underwent groin hernia repair between 2012 and 2018. Surgical expertise was categorized as either specialist or resident surgeon. Primary outcome was dissatisfaction and chronic pain 1 year post-surgery. Secondary outcome was reoperation for recurrence with follow-up until 2024.<h4>Results</h4>In total, 62 033 groin hernia repairs were analyzed, with a response rate of 70% for PROM questionnaire. Moreover, 72% of surgeries were performed by specialists and 28% by resident surgeons. Multivariable analysis revealed no significant differences. In the specialist group, 5.7% reported dissatisfaction compared to 4.5% in the resident group (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.84-1.02). Chronic pain was experienced by 15.4% of specialist operated patients and 15.5% of resident operated patients (OR 1.05, 95% CI 0.99-1.12). And 2.6% of patients in the specialist group underwent reoperation for recurrence, compared to 2.3% in the resident group (hazard ratio 0.97, 95% CI 0.86-1.11).<h4>Conclusion</h4>Groin hernia repairs represent a significant surgical procedure for resident surgeons in training. The level of surgical expertise was not found to be associated with increased long-term complications, suggesting that resident surgeons do not affect groin hernia patients negatively.