SP9.14 “Happy to close?”: The relationship between surgical experience and incisional hernia rates following abdominal wall closure in colorectal surgery

Abstract Introduction There is an association between surgeon volume and outcomes in hernia surgery, yet little evidence regarding impact of the experience of the surgeon performing abdominal wall closure (AWC) on IH rate. Our aim was to assess the rates of IH at 1 year following surgery between Registrar and Consultant surgeons in patients undergoing elective colorectal surgery. Methods Patients undergoing elective surgery for colorectal cancer between 2014-2018 were identified through the Hughes Abdominal Repair Trial (HART). Grade of surgeon performing AWC was categorised into “Trainee” and “Consultant” and compared with IH detected at clinical examination at 1 year following surgery. Results 663 patients were included. 44% were closed by registrars (n=289). Groups were comparable in BMI, previous surgery and pre-operative IH. The rate of IH in patients closed by registrars was significantly higher than those closed by consultants (20% vs 12%, p<0.01). Patients who underwent AWC by a registrar were 88% more likely to develop IH at 1 year (OR 1.88, 95%CI 1.23-2.86, p<0.01). When comparing AWC methods, IH rates were significantly higher in the Hughes closure arm (20% vs 12%, p=0.03), but not high enough in the mass closure arm to reach significance (21% vs 13%, p=0.05). Conclusion Patients who undergo AWC by a registrar have an increased risk of developing IH compared to those closed by a consultant. This work suggests the importance of training during AWC. Further work is needed to determine the impact of supervised and un-supervised trainees on IH rates, but AWC should be treated as training time rather than coffee time.