Economic Evaluation of Hospital Costs Associated with Laparoscopic and Open Inguinal Herniorrhaphy

Fernando Spencer Netto, MD, PhD, FRCSC, Bruna Camilotti, MD, Kristen Pitzul, Todd Penner, MD, FRCSC, Timothy Jackson, MD, FRCSC, Fayez Quereshy, MD, FRCSC, Allan Okrainec, MD, FRCSC

Toronto Western Hospital, University Healthy Network, University of Toronto

INTRODUCTION: Inguinal hernia repair is one of the most common surgical procedures performed worldwide. Several studies have validated the clinical utility of laparoscopic inguinal herniorrhaphy and have demonstrated comparable long-term recurrence rates. In addition, laparoscopic surgery may enable enhanced recovery in the perioperative period. Given increasing fiscal constraints, procedural cost-effectiveness has become a critical metric in evaluating surgical procedures. The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal hernia repairs.

METHODS AND PROCEDURES: Using a prospectively maintained database, 211 patients who underwent elective unilateral inguinal hernia repair (117 open and 94 laparoscopic) and 33 patients following elective bilateral inguinal hernia repair (9 open and 24 laparoscopic) from April 2009 to March 2011 were identified. A retrospective review of electronic patient records was performed along with a standardized case-costing analysis using data from the Ontario Case Costing Initiative. Monetary values are shown in Canadian dollars and were converted to 2012 value using consumer price index inflationary adjustments. Chi-square and the Mann-Whitney U tests were used for categorical and continuous variables respectively.

RESULTS: Laparoscopic repair was associated with a longer median operative time and required the use of general anesthesia in all cases. Operating room (OR) and total hospital costs (from pre-admission to discharge) for open unilateral inguinal hernia repair were significantly lower than the laparoscopic approach (median total cost for open surgery = $3386.64; TAPP = $3857.63 and TEP = $3803.23; P-value <0.05). However, OR and total hospital cost for repair of elective bilateral inguinal hernias were similar when comparing the open and laparoscopic approach (median total cost for open surgery = $4779.38; TAPP= $4891.56; TEP = $4769.33). When comparing unilateral or bilateral hernia repair within the laparoscopic cohort, there was no statistical difference in the cost (either OR or total episode of care) between the TAPP versus the TEP technique.

CONCLUSIONS: In the setting of a Canadian university hospital, when considering the repair of an elective unilateral inguinal hernia, the OR and total hospital costs of open surgery are significantly lower than the laparoscopic techniques. There is no statistical difference between OR and total hospital costs when comparing open surgery or laparoscopic techniques for repair of bilateral inguinal hernias. Further studies evaluating the economic utility and opportunity costs are necessary to elucidate the differences between elective open and laparoscopic inguinal herniorrhaphy that may extend beyond monetary evaluation alone.

Session: Podium Presentation

Program Number: S015

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