Dietric L Hennings, MD, Priscila R Armijo, MD, Dmitry Oleynikov, MD. University of Nebraska Medical Center
Introduction: Many publications have focused on single surgeon or single center data comparing the three different approaches to inguinal hernia repair. The aim of this study is to evaluate patient outcomes including complications, length of stay (LOS) and pain medication utilization of patients who underwent an open (OIHR), laparoscopic (LIHR) or robotic (RIHR) inguinal hernia repair using a national database.
Methods: The Vizient clinical database resource manager (CDB/RM) was queried using ICD-9 and ICD-10 procedure and diagnosis codes for patients who underwent each inguinal hernia repair approach from October 2013 to June 2017. Only patients who underwent elective procedures, and classified as minor or moderate risk severity were included. Severity was defined by a validated clinical algorithm that assesses 29 comorbidities, patient demographics and major diagnosis. Complications, 30-day readmission, mortality, LOS, and intra-hospital opiate utilization were analyzed using IBM SPSS v.23.0. Median tests with post-hoc pairwise comparisons, Fischer’s exact and Pearson’s chi-squared test with Bonferroni correction were applied where appropriate, with α=0.05.
Results: 3,547 patients (OIHR: N=2,413, LIHR: N=540, RIHR: N=594) met the criteria and were included in the study. Majority of patients were male (OIHR:84.1%, LIHR:80.4%, RIHR:95.3%), older than 51 years (OIHR:81.5%, LIHR:81.7%, RIHR:95.3%), and Caucasian (OIHR:75.7%, LIHR:77.0%, RIHR:81.5%). RIHR had the lowest rate of overall complications (0.67%) compared to both IHR (4.44%) and OIHR (3.85%), p<0.05. Whereas OIHR had the highest postoperative infection rate (8.33%), versus IHR (0.56%) and RIHR (0.0%), p < 0.05. OIHR had also longer length of stay (3.57±4.1 days) when compared to both groups (LIHR:2.2±2.13 days, RIHR:1.75±1.62 days), p<0.001. OIHR had a significantly higher 30-day readmission rate (3.61%) compared to the robotic approach (0.84%), p=0.001. Mortality rates were similar between groups (OIHR:0.21%, LIHR:0.19%, RIHR:0.17%), p=0.081. Opiate use was significantly higher in the OIHR group (96.0%), compared to both LIHR (93.1%), and RIHR (93.8%), p=0.004.
Conclusion: This study demonstrates improved outcomes of robotic inguinal hernia repair compared to an open or laparoscopic approach. Robotic hernia repair showed overall lower 30-day complication and readmission rates, and shortened LOS. While open approach had the highest rate of opiate use, no difference was seen in those rates between laparoscopic and robotic repairs. Research determining the role of robotic-assisted inguinal hernia repair continues to evolve as database capture provides more perspective. Further studies are needed to assess whether surgeon or patient selection contribute to those outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87010
Program Number: P777
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster