Impact of an abdominal wall surgery specialist on incisional hernia outcomes: A registry-based analysis

Abstract

Introduction General surgery is undergoing progressive super-specialization with conditions previously managed by general surgeons now being treated by super-specialists (SS). No universal criteria currently exist to define abdominal wall surgery super-specialization (AWS-SS), and the designation remains a self-reported classification. The aim of our paper is to evaluate the outcomes of incisional hernia (IH) procedures in the context of super-specialization or not, focusing on complications and recurrence rates. Methods All patients who underwent elective and emergency IH repair with mesh between 2017 and 2022 were included in the Spanish IH registry (EVEREG database). At the time of data inclusion, surgeons self-identified as either super-specialists or not (SS vs NSS), using no predefined criteria. Patients were divided into 2 groups: those performed by SS or NSS. Using a 1:1 matched analysis, differences in the incidence of complications and recurrence rates within 30 days, 6 months, one year, or 2 years of follow up were compared. Results A total of 6231 IH procedures were analyzed, 3441 (55.2%) of which were recorded as having been performed in the presence of a super-specialist. After matching, 4680 IH procedures were included in the final analysis. IH repairs performed in the presence of a super-specialist were associated with a lower incidence of surgical site occurrences (SSO), reduced recurrence rates within the first 2 years of follow-up, and lower rates of bulging and overall complications. Conclusions Involvement of a super-specialist in the repair of an IH can be associated with lower complication rates and reduced recurrence.

Introducción La cirugía general está experimentando una superespecialización progresiva. No existen criterios universales para definir a un superespecialista (SE) en cirugía de la pared abdominal (AWS SE), la designación se basa en una autodefinición por parte del cirujano. El objetivo es evaluar los resultados (complicaciones y tasas de recurrencia) de la intervención de hernia incisional (HI) en presencia o no de un SE. Métodos Todos los pacientes con reparación electiva y urgente de IH con malla entre 2017 y 2022 incluidos en el registro español de IH (EVEREG). Los pacientes se dividieron en dos grupos: los realizados en presencia o no de un SE. Mediante un análisis emparejado 1:1, se compararon las diferencias en complicaciones y tasas de recurrencia a los 30 días, seis meses, un año o dos años de seguimiento. Resultados Se analizaron un total de 6.231 procedimientos de IH. Se identificaron 3.441 (55,2%) intervenciones realizadas en presencia de un SE. Tras el emparejamiento, se incluyeron en el análisis final 4.680 procedimientos de IH. La reparación de IH realizada en presencia de un SE se asocia a una menor incidencia de SSO, menores tasas de recurrencia en los dos primeros años de seguimiento y menores tasas de “abombamiento” y complicaciones generales. Conclusiones La presencia de un SE en la reparación de un IH puede asociarse a una menor tasa de complicaciones y a una menor recurrencia.