Surgical unit volume and recurrence after open groin hernia mesh repair: A nationwide register-based cohort study.

BACKGROUND

Outcomes after open anterior mesh groin hernia repair may be influenced by surgical volume, but the extent of this relationship remains unclear. Although open anterior mesh-groin hernia repair is widely used, limited evidence exists on how surgical unit volume affects recurrence and postoperative complications. This study aimed to compare outcomes between high- and low-volume surgical units performing open anterior mesh-groin hernia repairs.

METHODS

A nationwide, population-based, cohort study with prospectively collected data from the Swedish Hernia Register was conducted. All patients aged 15 and older who underwent an open anterior mesh-groin hernia repair between 2015 and 2021 were included. Surgical units were categorized by their average annual volume: low (<25), low-medium (25-49), medium-high (50-150), and high (>150). The primary outcome was reoperation for recurrence with follow-up until 2024. The secondary outcome included postoperative complications within 30 days.

RESULTS

Totally, 64,589 open anterior mesh-groin hernia repairs from 103 units were analyzed. Reoperation rates for recurrence ranged from 1.9% to 2.8% across all volume groups. Only medium-high volume units showed a modestly significantly increased risk of reoperation for recurrence (hazard ratio, 1.14; 95% confidence interval, 1.03-1.27) compared with high-volume units. Emergency repairs at low-volume units had a significantly increased risk with a hazard ratio of 2.13 (95% confidence interval, 1.11-4.11). Postoperative complications were significantly more common in medium-high (odds ratio, 1.22; 95% confidence interval, 1.15-1.29) and low-medium units (odds ratio, 1.21; 95% confidence interval, 1.09-1.35).

CONCLUSION

Surgical unit volume had a limited impact on outcomes after elective open anterior mesh groin hernia repairs. However, emergency repairs at low-volume units showed an increased reoperation risk for recurrence, indicating increased sensitivity to surgical experience in emergency settings.