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Closing the gap between the laparoscopic and open approaches to abdominal wall hernia repair: a trend and outcomes analysis of the ACS-NSQIP database

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Abstract

Objective

To assess trends in utilization and perioperative outcomes of laparoscopic and open abdominal wall hernia repair.

Methods

Using the ACS-NSQIP database between 2009 and 2012, patients were identified as having an ICD-9 diagnosis of an umbilical, ventral, or incisional hernia as well as a CPT code for a laparoscopic or open abdominal wall hernia repair. A coarsened exact matching procedure was utilized to create a matched cohort to mitigate selection bias. Thirty-day outcomes analysis was done for the aggregate and matched cohorts. Subcategory analysis was performed for inpatient/outpatient status, strangulated/incarcerated hernias, initial/recurrent repairs, and hernia type (umbilical, ventral, incisional). Chi-square analysis was performed to determine the statistical significance of each comparison.

Results

In total, 112,074 qualifying patients were identified, 86,566 (77.24 %) open and 25,508 (22.76 %) laparoscopic. Patients undergoing laparoscopic repair were more likely to have preexisting comorbidities, but less likely to experience any postoperative morbidity (11.74 vs. 7.25 %, P < 0.0001), serious morbidity (4.55 vs. 3.02 %, P < 0.0001), or mortality (0.36 vs. 0.24 %, P = 0.0030). Creation of the matched cohort produced 17,394 patients in both the laparoscopic and open groups and resulted in a loss of advantage for the laparoscopic approach in terms of morbidity associated with umbilical hernia repairs (P = 0.0082 vs. P = 0.3172). Patients undergoing laparoscopic repair were still less likely to experience any postoperative (9.57 vs. 4.92 %, P < 0.0001) or serious morbidity (3.37 vs. 1.70 %, P < 0.0001). Hospital length of stay in the matched cohort supported initial primary repairs done by an open approach.

Conclusion

The laparoscopic approach is used in a minority of abdominal wall hernia repairs, though utilization increased by 40 % from 2009 to 2012. The laparoscopic approach continues to be safer on many fronts, but not all, and is arguably not better for umbilical or primary hernia repairs on the basis of overall morbidity and length of stay.

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Notes

  1. Those with a postoperative diagnosis of ICD-9 codes 551.1, 551.2, 551.21, 551.29, 552.1, 552.2, 552.21, 552.29, 553.1, 553.2, 553.21, and 553.29 were included, as well as those with a CPT code of 49560, 49561, 49565, 49566, 49568, 49570, 49572, 49580, 49582, 49585, 49587, 49590, 49652, 49653, 49654, 49655, 49656, 49657, and 49659.

  2. Exclusionary ICD 9 codes: 550 (inguinal hernia), 551.0, 552.0, 553.0 (femoral hernia), 551.3, 552.3, 553.3 (diaphragmatic hernia), 551.8, 552.8, 553.8 (hernia of other specified site), 551.9, 552.9, 553.9 (hernia of unspecified site).

  3. CPT codes 49560, 49561, 49565, 49566, 49568, 49570, 49572, 49580, 49582, 49585, 49587.

  4. CPT codes 49590, 49652, 49653, 49654, 49655, 49656, 49657, 49659.

  5. Also cited as “non-reducible.”

  6. Note that the PUF does not include any individuals under the age of sixteen, and identifies all individuals over the age of 90 simply as 90+.

  7. As calculated from height and weight data. Formula: (weight/height2) × 703.

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Authors and Affiliations

  1. Department of Surgery, NYU School of Medicine, NYU Langone Medical Center, 530 First Ave, HCC 6-C, New York, NY, 10016, USA

    Samantha L. Savitch & Paresh C. Shah

Authors
  1. Samantha L. Savitch
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  2. Paresh C. Shah
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Correspondence to Paresh C. Shah.

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Disclosures

Ms. Savitch has no conflicts of interest or financial ties to disclose. Dr. Shah has a consulting relationship with Stryker, Olympus, Endoevolution, Easton Capital, and Zmicro Systems, none of which are relevant to this study.

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Savitch, S.L., Shah, P.C. Closing the gap between the laparoscopic and open approaches to abdominal wall hernia repair: a trend and outcomes analysis of the ACS-NSQIP database. Surg Endosc 30, 3267–3278 (2016). https://doi.org/10.1007/s00464-015-4650-7

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  • DOI: https://doi.org/10.1007/s00464-015-4650-7

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