TY - JOUR
T1 - “Happy to close?” The relationship between surgical experience and incisional hernia rates following abdominal wall closure in colorectal surgery
AU - HART Trial Collaborators
AU - Smith, Laurie
AU - Coxon-Meggy, Alexandra
AU - Shinkwin, Michael
AU - Cornish, Julie
AU - Watkins, Alan
AU - Fegan, Greg
AU - Torkington, Jared
AU - Torkington, J.
AU - Harries, R.
AU - O’Connell, S.
AU - Knight, L.
AU - Islam, S.
AU - Bashir, N.
AU - Watkins, A.
AU - Fegan, G.
AU - Cornish, J.
AU - Rees, B.
AU - Cole, H.
AU - Jarvis, H.
AU - Jones, S.
AU - Russell, I.
AU - Bosanquet, D.
AU - Cleves, A.
AU - Sewell, B.
AU - Farr, A.
AU - Zbrzyzna, N.
AU - Fiera, N.
AU - Ellis-Owen, R.
AU - Hilton, Z.
AU - Parry, C.
AU - Bradbury, A.
AU - Wall, P.
AU - Hill, J.
AU - Winter, D.
AU - Cocks, K.
AU - Harris, D.
AU - Hilton, J.
AU - Vakis, S.
AU - Hanratty, D.
AU - Rajagopal, R.
AU - Akbar, F.
AU - Ben-Sassi, A.
AU - Pinkney, T.
AU - Ward, S.
AU - Pollard, J.
AU - Bach, S.
AU - Morton, D.
AU - Glasbey, J.
AU - Wilkin, R.
AU - Suggett, N.
N1 - Publisher Copyright:
© 2023 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
PY - 2023/6
Y1 - 2023/6
N2 - Aim: Incisional hernia (IH) is a common complication of colorectal surgery, affecting up to 30% of patients at 2 years. Given the associated morbidity and high recurrence rates after attempted repair of IH, emphasis should be placed on prevention. There is an association between surgeon volume and outcomes in hernia surgery, yet there is little evidence regarding impact of the seniority of the surgeon performing abdominal wall closure on IH rate. The aim of our study was to assess the rates of IH at 1 year following abdominal wall closure between junior and senior surgeons in patients undergoing elective colorectal surgery. Methods: This was an exploratory analysis of patients who underwent elective surgery for colorectal cancer between 2014–2018 as part of the Hughes Abdominal Repair Trial (HART), a prospective, multicentre randomised control trial comparing abdominal wall closure methods. Grade of surgeon performing abdominal closure was categorised into “trainee” and “consultant” and compared to IH rate at one year. Results: A total of 663 patients were included in this retrospective analysis of patients in the HART trial. The rate of IH in patients closed by trainees was 20%, compared to 12% in those closed by consultants (p = <0.001). When comparing closure methods, IH rates were significantly higher in the Hughes closure arm between trainees and consultants (20% vs. 12%, p = 0.032), but not high enough in the mass closure arm to reach statistical significance (21% vs. 13%, p = 0.058). On multivariate analysis, age (p = 0.036, OR: 1.02, 95% CI: 1.00–1.04), Male sex (p = 0.049, OR: 1.61, 95% CI: 1.00–2.59) and closure by a trainee (p = 0.006, OR: 1.85, 95% CI: 1.20–2.85) were identified as risk factors for developing IH. Conclusion: Patients who undergo abdominal wall closure by a surgeon in training have an increased risk of developing IH when compared to those closed by a consultant. Further work is needed to determine the impact of supervised and unsupervised trainees on IH rates, but abdominal wall closure should be regarded as a training opportunity in its own right.
AB - Aim: Incisional hernia (IH) is a common complication of colorectal surgery, affecting up to 30% of patients at 2 years. Given the associated morbidity and high recurrence rates after attempted repair of IH, emphasis should be placed on prevention. There is an association between surgeon volume and outcomes in hernia surgery, yet there is little evidence regarding impact of the seniority of the surgeon performing abdominal wall closure on IH rate. The aim of our study was to assess the rates of IH at 1 year following abdominal wall closure between junior and senior surgeons in patients undergoing elective colorectal surgery. Methods: This was an exploratory analysis of patients who underwent elective surgery for colorectal cancer between 2014–2018 as part of the Hughes Abdominal Repair Trial (HART), a prospective, multicentre randomised control trial comparing abdominal wall closure methods. Grade of surgeon performing abdominal closure was categorised into “trainee” and “consultant” and compared to IH rate at one year. Results: A total of 663 patients were included in this retrospective analysis of patients in the HART trial. The rate of IH in patients closed by trainees was 20%, compared to 12% in those closed by consultants (p = <0.001). When comparing closure methods, IH rates were significantly higher in the Hughes closure arm between trainees and consultants (20% vs. 12%, p = 0.032), but not high enough in the mass closure arm to reach statistical significance (21% vs. 13%, p = 0.058). On multivariate analysis, age (p = 0.036, OR: 1.02, 95% CI: 1.00–1.04), Male sex (p = 0.049, OR: 1.61, 95% CI: 1.00–2.59) and closure by a trainee (p = 0.006, OR: 1.85, 95% CI: 1.20–2.85) were identified as risk factors for developing IH. Conclusion: Patients who undergo abdominal wall closure by a surgeon in training have an increased risk of developing IH when compared to those closed by a consultant. Further work is needed to determine the impact of supervised and unsupervised trainees on IH rates, but abdominal wall closure should be regarded as a training opportunity in its own right.
KW - abdominal wall closure
KW - incisional hernia
KW - surgical training
UR - http://www.scopus.com/inward/record.url?scp=85151086039&partnerID=8YFLogxK
U2 - 10.1111/codi.16537
DO - 10.1111/codi.16537
M3 - Article
C2 - 36965056
AN - SCOPUS:85151086039
SN - 1462-8910
VL - 25
SP - 1222
EP - 1227
JO - Colorectal Disease
JF - Colorectal Disease
IS - 6
ER -
