Liam T Knott, MD1, I-Fan Shih, MS, PT2, Chao Song, MS3, T. Paul Singh, MD, FACS1. 1Albany Medical Center, 2UCLA Fielding School of Public Health, 3Global Health Economics & Outcomes Research
Objectives: Inguinal hernia repair (IHR) is a commonly performed surgical procedure by general surgeons worldwide. The outcomes of hernia recurrence have been difficult to quantitate. This study aimed to evaluate the outcome of recurrent inguinal hernia repair rate following a primary robotic-assisted (RAS), laparoscopic or open surgery.
Methods: Index outpatient IHRs were identified with Current Procedural Terminology (CPT) codes from Truven MarketScan Database from 2013 to 2015. Patients who had a recurrent IHR CPT code or gastrointestinal tract resections or any other hernia repairs were excluded. The primary outcome of interest was time to repeat IHR, defined by the presence of IHR CPT codes at least 7 days after the index IHR. We restricted to the recurrent IHR CPT codes to define the time to recurrent IHR. Cox proportional hazard model was used to compare the repeat or recurrent IHR rate between RAS, laparoscopic and open repairs, adjusting for age, sex, region, insurance plan, Charlson comorbidity index, obesity, smoking, constipation, bilateral IHR, Gangrene and/or obstructional IHR, strangulated IHR and the mesh use.
Results: Of 75981 index IHRs, 2858 patients (3.8%) underwent another IHR and 573 of those were recurrent IHR during the study period. The rate of repeat IHR was significantly lower in the Laparoscopic group than in the open group (hazard ratio [HR] =0.90, 95% confidence interval [CI] =0.83-0.98, p=0.019), and a trend of even lower rate of RAS compared to open IHR (HR=0.69, 95%CI=0.33-1.44, p=0.32). The results were unchanged when we limit to 6-month and 1-year follow-up and bilateral index IHR cases only. The rate of recurrence was significantly higher in the Laparoscopic group than in the open group (HR=1.32, 95%CI=1.09-1.59, p=0.004) and was similar to that in the RAS group HR=0.74, 95%CI=0.10-5.29, p=0.765).
Conclusion: Laparoscopic and Robotic-assisted surgical approach were found to reduce the rate of repeat IHR to open surgery among outpatient inguinal hernia patients. Yet, the recurrence rate was significantly higher in the laparoscopic approach than in the open one. Further analysis will be required to generate a complete understanding of the outcomes of the choice of primary procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88156
Program Number: S111
Presentation Session: Residents/Fellows Session
Presentation Type: ResFel