K. Keano Pavlosky, MS1, John D Vossler, MD2, Kenric M Murayama, MD2, Marilyn A Moucharite, MS3, Dean J Mikami, MD2. 1University of Hawaii John A Burns School of Medicine, Honolulu, HI, 2Department of Surgery, University of Hawaii John A Burns School of Medicine, Honolulu, HI, 3Medtronic Healthcare Economics Outcomes Research Division, New Haven, CT
INTRODUCTION: Inguinal hernia repair is among the most common procedures performed by general surgeons. Prior investigation indicates an individual surgeon’s experience with minimally invasive surgery (MIS) determines utilization. This study aimed to identify the effect of other factors, such as hospital, surgeon and patient demographics, as predictors of laparoscopic versus open inguinal hernia repair.
METHODS: We conducted a retrospective analysis of 342,814 inguinal hernia repairs performed in adults (≥ age 18) from 2010-2015, using the Premier Perspective Database. Included were 241,669 open and 101,145 laparoscopic procedures. Multivariable logistic regression was used to estimate the adjusted odds ratio of taking a laparoscopic approach compared to a reference group, with respect to ten demographic variables.
RESULTS: Use of laparoscopic MIS versus open inguinal hernia repair increased from 2010-2015 (Table 1). MIS repairs were more likely: if surgeons had larger inguinal hernia repair caseloads (≥ 45/year; OR = 1.57, CI = 1.53-1.60, p<0.0001), at large hospitals (>500 beds; OR = 1.36, CI = 1.33-1.39, p<0.0001), and in New England (OR = 2.38, CI = 2.29-2.47, p<0.0001). Likelihood of MIS was higher in patients < age 65 (OR = 1.28, CI = 1.24-1.31, p< 0.0001), males (OR = 1.31, CI = 1.27-1.34, p < 0.0001), patients with private insurance (OR = 1.36, CI = 1.33-1.40, p<0.0001) and those not White, Black or Hispanic (OR = 1.11, CI = 1.09-1.14, p<0.0001). Likelihood of MIS decreased by 13% with a one-unit increase in Charlson Comorbidity Index (CCI) value (OR = 0.876, CI = 0.865-0.886, p<0.0001). Non-predictors included urban/rural hospital location (OR = 1.02, CI = 0.10-1.05, p= 0.06) and hospital teaching status (OR = 1.01, CI = 0.99-1.03, p = 0.2084).
CONCLUSIONS: While the majority of inguinal hernia repairs are still open procedures, use of laparoscopic MIS is rising. Increased surgeon experience with inguinal hernia repair (higher annual caseload) remains a top predictor of MIS, along with hospital size and location. Additional study is necessary to understand links between patient age group, gender, race, insurance type and CCI as predictors of MIS for inguinal hernia repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86633
Program Number: P669
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster