Priscila R Armijo, MD1, Akshay Pratap, MBBS1, Yi Wang, PhD2, Dmitry Oleynikov, MD, FACS1. 1University of Nebraska Medical Center, 2University of Nebraska College of Public Health
Introduction: The adoption of minimal invasive surgery (MIS) over open surgery for ventral hernia repair has grown over the last decade. Whether outcomes are improved by robotic assistance still remains a subject of debate. The aim of this study is to evaluate patient outcomes including, cost, complications, length of stay (LOS) and pain medication utilization of patients who underwent an open (OVHR), laparoscopic (LVHR) or robotic (RVHR) ventral hernia repair.
Methods: The UHC clinical database resource manager (CDB/RM) was queried using ICD-9 procedure and diagnosis codes for patients who underwent each VHR approach from January 2013 to September 2015. Complications, 30-day readmission, mortality, LOS, cost and intra-hospital opiate utilization were analyzed using IBM SPSS v.188.8.131.52. 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: 46,799 patients (OVHR: N=39,505, LVHR: N=6,829, RVHR: N=465) met the criteria and patients in each group had similar demographics (Table 1). OVHR was associated with significant increased overall complications, 30-day readmission, LOS and postoperative pain use compared to either robotic or laparoscopic approaches. OVHR also had higher mortality and postoperative infection rates than LVHR, but not than RVHR. RVHR had significantly higher rates of complications and postoperative infections compared to LVHR; although there was no difference in mortality, 30-day readmission, LOS and postoperative pain medication use. Mean direct cost of surgery was significantly higher for RVHR, followed by OVHR and least costly was LVHR.
Conclusion: Overall patient outcomes were improved in the LVHR and RVHR groups compared to open approach. However, RVHR patients did not have a significant improvement compared with the LVHR group in either short-term outcomes or opiate medication used. While RVHR surgery was the most expensive modality, OVHR was also significantly costlier than LVHR, which was the least expensive. Long-term data on recurrence could not be evaluated and should be studied to determine the role of robotic surgery in ventral hernia repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79127
Program Number: S108
Presentation Session: Hernias: Inguinal and Robotics
Presentation Type: Podium