Most of us assume the answer to that question is obvious. The more times a surgeon performs an operation, the better the outcomes should be. But in our current healthcare system, “experience” is often categorized into high-volume or low-volume… without anyone agreeing on what those terms actually mean.
Over the weekend, I read a study that forced me to stop and reflect not just on the definitions and data, but also on my own surgical career.
The paper, “Is Quantity Quality? The Impact of Surgeon Volume on Outcomes in Inguinal Hernia Repair: A Quantitative Systematic Review,” examines re-operation and complication rates for groin hernia repairs based on a surgeon’s annual case volume.
At first glance, the results were not overwhelmingly convincing.
The re-operation rate for high-volume hernia surgeons was approximately 2.00%, while low-volume surgeons had a rate of 2.48%. While this difference reached statistical significance, the margin was low, raising an important question: If experience matters, why doesn’t the data show a more dramatic difference?
Well, let’s break it down:
In this study, a high-volume hernia surgeon was defined as someone performing more than 50 hernia repairs per year. Medium volume was 25–50 cases annually, and low volume was fewer than 25.
Based on more than 20 years in practice, I’m not sure those definitions capture the reality of surgical expertise.
Early in my career, I worked in a small community hospital where I repaired more than 200 hernias per year. Later, after transitioning to a larger teaching hospital, that number dropped below 100. I could feel the difference in my technique almost immediately. Surgery became less intuitive. I had to think more deliberately through each step. I was less efficient.
That experience shaped how I define surgical volume. In my opinion, a high-volume hernia surgeon repairs a lot more than 100 hernias per year. Once over that threshold, the meaningful drop in reoperation and complication rates is evident because the surgeon has the repair down to a science.
It’s also worth mentioning that studies like this one do not fully capture surgeons who perform hundreds of hernia repairs annually. At Boston Hernia, hernia surgery is all we do. And, as my operative volume increased towards 500 repairs per year, I saw my complication and reoperation rates fall even further. Surgery became more efficient and my decision-making became increasingly precise. These changes are difficult to measure in large datasets, but are very evident in daily practice.
So, what?
This study reinforces an important truth: it matters who repairs your hernia. At the same time, it also highlights a limitation in how surgical experience is measured. When “high volume” is defined too broadly, meaningful differences between generalists and true specialists can be hard for patients to find.
The real difference in efficiency, technical mastery, and outcomes emerge at higher volumes, when hernia repairs are consistently and deliberately performed by experts.
For patients, these results show the importance of seeking out surgeons who specialize in hernia care. Take the time to do the research, learn about the repair, and select a surgeon who best aligns with your goals.