S Cassie, MD, FRCSC, A Okrainec, MDCM, MHPE, FACS, FRCSC, F Saleh, MD, FRCSC, F A Quereshy, MD, MBA, FRCSC, T D Jackson, MD, MPH, FRCSC
Department of Surgery, University of Toronto, Toronto, ON, Canada
Over 150,000 umbilical hernia repairs are completed in the United States annually. While the laparoscopic approach has been widely embraced for a variety of hernia repairs, there remains controversy regarding the optimal approach for the repair of primary umbilical hernias. The objective of this study was to compare 30-day outcomes of elective primary open (OHR) and laparoscopic (LHR) umbilical hernia repairs, using a prospectively collected data set.
We performed a retrospective cohort study using the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) Participant Use Files during 2009 and 2010. Patients greater than 16 years old undergoing repair of primary umbilical hernias were included for analysis. Both CPT codes and post-operative ICD-9 diagnostic codes were used to identify patients to include in this study. Primary outcomes included composite endpoints of 30-day overall complications, 30-day major complications, and 30-day mortality for the LHR and OHR groups. Both univariate analyses and multivariate logistic regression were performed controlling for relevant patient characteristics. Secondary outcomes included a comparison of mean operative time and mean hospital length of stay.
A total of 14,885 patients were identified, 13,326 (89.5%) in the open group and 1559 (10.5%) in the laparoscopic group. At baseline, the LHR group had a significantly higher mean BMI, male predominance, and a higher ASA class. Univariate analyses of our primary outcomes demonstrated similar 30-day morbidity and mortality between the two groups. In our multivariate model, however, after controlling for BMI, gender, ASA, COPD, and type of anaesthetic, the odds ratio (OR) for overall complications favored the laparoscopic group (OR 0.59, p=0.01). This difference was driven primarily by the lower rate of wound complications in the LHR group (OR 0.41, p=0.01). The multivariate model for major complications did not reveal a significant difference between the two groups (OR 1.01, p=0.95). There were too few events to perform multivariate analysis on 30-day mortality. The secondary outcome of mean operative time was significantly higher for the LHR group (57.5 min, SD 32.5) compared to the OHR (38.4 min, SD 23.0) group (p< 0.001). The mean length of stay was significantly longer after a laparoscopic repair compared to open repair (0.29 days, SD 0.68 vs. 0.17 days, SD 1.49), p= 0.002.
This study identifies potential decreased morbidity associated with the laparoscopic approach for elective primary umbilical hernia repairs. However, LHR was found to have an increase in mean operative time and length of stay. These results should be considered within the context of a retrospective study with its inherent associated risks of bias and limitations.
Session: Podium Presentation
Program Number: S112