The volume-outcome relationship for incisional hernia repair: analysis of an administrative dataset for England.

PURPOSE: Incisional hernia is a common complication following abdominal surgery and repair can be complex. We aimed to use an administrative dataset for England to investigate the relationship between surgeon and provider volumes and outcomes.

METHODS

We used data from the Hospital Episodes Statistics database for adult incisional hernia repair conducted in England from 1st April 2013 to 31st March 2025. The exposure variables were annual surgeon and provider volume defined as the number of procedures conducted in the 12 months prior to the index procedure. The primary outcome was reintervention surgery within two-years. Secondary outcomes were reintervention surgery at one and five years, length of stay greater than the median, 30-day all-cause emergency readmission and post-surgery complications. The relationship was modelled using multilevel, multivariable logistic regression with adjustment for prespecified covariates.

RESULTS

Data were available for 75,664 incisional hernia repairs conducted by 4355 surgeons within 165 providers. There was a significant relationship between greater surgeon annual volume and lower rates of reintervention surgery at two years (OR 0.995 (95% CI 0.992 to 0.998), p = 0.002) and five years (OR 0.994 (95% CI 0.991 to 0.997), p < 0.001) and between greater hospital provider volume and stay greater than the median (OR 1.001 (95% CI 1.000 to 1.002), p = 0.004). There was no relationship between volume and other short-term surgical outcomes.

CONCLUSIONS

A relationship exists between lower surgeon volume and higher rates of reintervention surgery for incisional hernia repair. There was no relationship between lower surgeon or provider volume and poorer peri-surgical complications. Setting minimum surgeon annual volume thresholds may help to improve repair rates.