Laparoscopic Versus Open Hernia Repair, Results From the Nationwide Inpatient Sample

P D Colavita, MD, A L Walters, MS, V B Tsirline, MD, A E Lincourt, PhD, B T Heniford, MD. Carolinas Medical Center, Charlotte, NC

 

Introduction:
Laparoscopic ventral hernia repair has become increasingly popular since its inception. The purpose of this study is to compare laparoscopic and open ventral hernia repair with mesh in the United States, using the Nationwide Inpatient Sample (NIS).

Methods:
The NIS, a representative sample of approximately 20% of all inpatient encounters in the USA, was queried for all ventral hernia repairs with graft or prosthesis in 2009 using ICD-9-CM codes. Patients with other anterior abdominal wall hernias, such as umbilical or peristomal, or who had a resection of any portion of the digestive tract were excluded. The remaining patients were stratified into laparoscopic and open repairs. Socio-demographic data, comorbidities, complications (splenectomy, GI tract laceration, transfusion, total parenteral nutrition use, and infections) and outcomes (in-hospital death, length of stay (LOS), and total charges) were compared between groups. The Charlson comorbidity index, a commonly used and well validated index designed to calculate mortality risk of 22 weighted comorbidities, was employed to compare comorbidities of the patients in both groups based on ICD-9-CM coding.

Results:
A total of 11804 cases were documented in the NIS sample after inclusion and exclusion criteria were met. Laparoscopic repairs were performed 27.4% of the time. There were no statistically significant differences in race, gender, or mean income by zip-code. Mean age (58.76 years in open group vs. 58.05 years, p=0.0087) and mean Charlson score (3.54 vs 3.48, p<0.0001) differed significantly between groups. Open surgery was more often associated with emergent admissions (21.7% vs 15.1%, p<0.0001). There were significant differences comparing complications and outcomes between open and laparoscopic groups: complication rate (7.54% vs. 3.77%, p<0.0001), average LOS (5.1 days vs. 3.5days, p<0.0001), total charge ($45700 vs $36400, p<0.0001), and mortality rate (0.88% vs 0.36%, p=0.0002). After controlling for confounding variables with multivariate regression, LOS and mortality rate did not significantly differ between groups. The difference in total charges remained significant (p=0.0032), and complication rate remained significantly more likely after open surgery (OR 1.54, p<0.0001).

Conclusion:
Laparoscopic ventral hernia repair with mesh results in fewer complications and lower hospital charges compared to open repair. Patient comorbidities and selection bias may limit the number of patients who receive laparoscopic ventral hernia repair. Regionalization studies may better illuminate the low rates of laparoscopic surgery.
 


Session Number: ResFel – Residents/Fellows Scientific Session
Program Number: S134

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