Association between cumulative surgeon experience and long-term outcomes in complex abdominal wall reconstruction

A. M. Hassan, N. R. Shah, M. Asaad, S. K. Kapur, D. M. Adelman, M. W. Clemens, D. P. Baumann, M. M. Hanasono, J. C. Selber, C. E. Butler

Research output: Contribution to journalArticlepeer-review


Purpose: While many factors have been correlated with lesser outcomes in abdominal wall reconstruction (AWR), the impact of surgeon experience has yet to be elucidated. We sought to evaluate the effect of cumulative surgeon experience on long-term complex AWR outcomes. Methods: We conducted a comprehensive review of all consecutive patients who underwent AWR using biologic mesh for the repair of ventral hernias or tumor resection defects from March 2005 to June 2019. The primary outcome measure was hernia recurrence (HR). Secondary outcomes were surgical site occurrences (SSOs) and surgical site infections (SSIs). Patients were a priori categorized into the following groups according to the cumulative number of hernia repairs performed by their surgeons: low (< 50), moderate experience (50–100), and high (> 100) experience. Results: We identified 60 surgeons and 650 consecutive patients (62% women) who met our inclusion criteria. In adjusted models, AWR performed by surgeons with high experience was associated with a fourfold lower risk of HR (hazard ratio, 0.28; 95% confidence interval, 0.08 to 0.87), but the odds of surgical site occurrences (odds ratio, 0.72, 95% confidence interval, 0.34 to 1.52) and surgical site infections (odds ratio, 0.89, 95% confidence interval, 0.26 to 2.86) did not differ significantly in the high-experience group. Conclusions: High surgical experience, defined as > 100 cumulative hernia repairs, is predictive for markedly lower HR rates in complex AWR. These findings have potential implications for preoperative risk assessment, patient-centered surgeon selection, regulatory oversight, specific referral patterns, designations of centers of excellence, and individual provider or trainee quality improvement.

Original languageEnglish (US)
StateAccepted/In press - 2022


  • Abdominal wall reconstruction
  • Cumulative experience
  • Hernia recurrence
  • Outcomes
  • Surgeon experience
  • Surgical complications
  • Ventral hernia repair
  • Years of experience

ASJC Scopus subject areas

  • Surgery


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