Surgical unit volume has a minor influence on recurrence rates after open groin hernia repairs, which is crucial for optimizing patient outcomes.

• Reoperation rates for recurrence range from 1.9% to 2.8%, with medium-high volume units showing a significant increase (hazard ratio 1.14).
• Emergency repairs at low-volume units have a concerning increased reoperation risk (hazard ratio 2.13).

Surgeons should consider unit volume when selecting sites for elective and emergency groin hernia repairs.

• Complications are more prevalent in medium-high (odds ratio 1.22) and low-medium (odds ratio 1.21) volume units.