Predictors of Robotic Versus Laparoscopic Inguinal Hernia Repair

John D Vossler, MD, MS, MBA¹, Keano Pavlosky, MS², Kenric M Murayama, MD¹, Marilyn A Moucharite, MS³, Dean J Mikami, MD¹. ¹Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, ²John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, ³Medtronic Healthcare Economics Outcomes Research Division, New Haven, CT

INTRODUCTION: The advent of robotic-assisted surgery has added an additional decision point in the minimally invasive (MIS) treatment of inguinal hernias. The goal of this study is to identify the patient, surgeon, and hospital demographic predictors of robotic inguinal hernia repair.

METHODS: We conducted a retrospective analysis of 102,241 MIS inguinal hernia repairs (1,096 robotic, 101,145 laparoscopic) from 2010 through 2015 with data collected in the Premier Hospital Database. Patient, surgeon, and hospital demographics of robotic and laparoscopic inguinal hernia repairs were compared. The adjusted odds ratio of receiving a robotic procedure was calculated for each of the demographic factors using a multivariable logistic regression model. Statistical significance was defined as p<0.05. SAS software version 9.4 was used for statistical analysis.

RESULTS: The odds of a procedure being robotic increased from 2010 through 2015 (Table 1). Age <65 was not a predictor of a robotic procedure (OR=1.2, CI=0.95-1.51, p=0.1352). Females were more likely to receive a robotic procedure (OR=1.69, CI=1.40-2.05, p<0.0001). Compared to white patients, black patients were more likely (OR=1.33, CI=1.06-1.68, p=0.0138), and other race patients were less likely (OR=0.47, CI=0.38-0.58, p<0.0001) to receive a robotic procedure. Compared to Medicare insurance, patients will all other types of insurance were more likely to receive a robotic repair (Table 2). Surgeons with the lowest annual volume were the most likely to perform robotic procedures (Table 3). Non-teaching (OR=1.81, CI=1.53-2.13, p<0.0001), larger (Table 4), and rural (OR=1.27, CI=1.03-1.57, p=0.025) hospitals were more likely to perform robotic procedures.

CONCLUSIONS: The utilization of robotic inguinal hernia repair is rapidly increasing. Further research is necessary to investigate the apparent tendency toward selection of socioeconomically disadvantaged patients (black, Medicaid, uninsured) for robotic procedures.