Outcomes following Robotic Ventral Hernia Repair: A Study of 21, 565 Patients in the State of New York

Maria Altieri, MD, MS, Jie Yang, PhD, Aurora Pryor, MD, Jianjin Xu, MD, Andrew Bates, MD, Monica Cramer, MD, Mark Talamini, MD, Dana Telem, MD. Stony Brook

Introduction: With the increase of robotic surgery into areas of general surgery, there is paucity of data assessing its value and outcomes.  The purpose of our study is to assess outcomes following robotic ventral hernia repair.

Methods: Following appropriate board and state approvals, the New York Statewide Planning and Research Cooperative System (SPARCS) administrative database was used to identify all patients undergoing laparoscopic and robotic ventral hernia repair between 2010-2013.  Outcome measures including complications, hospital length of stay (HLOS), 30-day re-admissions, and 30-day emergency department (ED) visits were compared. Chi-squared tests were used to compare unadjusted marginal differences for categorical variables between groups. Welch’s ANOVA tests and non-parametric tests, such as Kruskal-Wallis tests or Wilcoxon rank sum tests were used to compare unadjusted marginal differences for continuous variables. Propensity score (PS) analysis was used to estimate the adjusted marginal (population average) differences between patients who underwent robotic-assisted and laparoscopic procedures. P<0.05 was considered significant.

Results: There were 20,896 laparoscopic and 679 (3.2%) robotic ventral hernia repairs. Initial univariate analysis demonstrated that patients undergoing robotic ventral hernia (RVH) had worse outcomes in terms of complications (5.85% vs 2.82%, p <.0001), longer HLOS (4.32 vs 2.19 days, p =0.0023), higher rates in 30-day readmissions (5.62% vs 3.01%, p <0.0001), and 30-day ED visits (4.29% vs 3.01%, p <.0001) compared with those who underwent laparoscopic ventral hernia (LVH).  However, patients undergoing RVH had more co-morbidities (79.97%) compared to LVH (40.54%) (p-value <0.0001).  Following PS analysis, which accounts for all patient associated variables, there was no difference found in 30-day readmission or 30-day ED visits between RVH and LVH  (p =0.2760 and 0.2043, respectively).  Patients undergoing RVH had a significantly shorter HLOS (p <0.0001) and lower rate of complications (risk difference between RVH and LVH was estimated to be 5.75% with 95% CI= (1.28-10.23% and p=0.0134).

Conclusion: Following propensity score analysis which corrects for patient selection bias, this study demonstrates that RVH may be advantageous to ventral hernia repair in terms of perioperative complication risk and hospital length of stay. Substratification and more clinically rich data, eg hernia size and characteristics, are needed before determining whom this technique may best benefit.

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