Descriptive statistics were used to summarize continuous variables and frequencies and percentages for categorical variables. A chi-squared test or Fisher exact test was used to compare the difference in the categorical variables among study groups. A t test or Wilcoxon rank sum test was used to test the difference of continuous variables. The time to hernia recurrence was defined as the time interval between the date of AWR and the date of hernia recurrence or the last follow-up, whichever occurred first. Patients who did not have hernia recurrence at the last follow-up date were censored in the analysis. Cumulative hernia recurrence-free probabilities were estimated using Kaplan-Meier product-limit method. A log-rank test was used to compare the distribution of hernia recurrence-free probability among various patient groups. Multilevel models were designed with patients nested within fellows. Multivariable hierarchical logistic regression models were used to evaluate the effect of the fellowship pathway on SSO, SSI, readmission within 30 days, and re-operation. A multivariable hierarchical frailty model was used to assess the impact of training pathways on time to hernia recurrence. A multivariable hierarchical mixed linear regression model was fitted for length of hospital stay. The logarithm transformation of length of stays was applied for better model fit. Patient-level covariates included patient demographics, and clinical and surgical characteristics. Results are presented using hazards ratio (HR), odds ratio (OR), and beta (β) coefficients. Two-tailed P values less than 0.05 were considered significant; all statistical analyses were performed using SAS Enterprise Guide software (version 9.4; SAS Institute Inc., Cary, N.C.) by a senior biostatistician (J.L.).