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Trends and outcomes of open, laparoscopic, and robotic inguinal hernia repair in the veterans affairs system

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A Comment to this article was published on 12 June 2021

Abstract

Purpose

Robotic inguinal hernia repair (RHR) is an evolving technique but is comparatively expensive and has yet to show superior outcomes versus open (OHR) or laparoscopic (LHR) approaches. The utilization and clinical outcomes of RHR have not been reported within the veterans affairs (VA) system. This study analyzes trends in utilization and 30-day post-operative outcomes between OHR, LHR, and RHR in veterans.

Methods

This is a retrospective review of patients that underwent inguinal herniorrhaphy using the Veterans Affairs Quality Improvement Program database. Multivariable analysis of outcomes was performed adjusting for pre-operative confounding covariates between OHR, LHR, and RHR. Trends in utilization, complication rates, and operative times were also reported.

Results

From 2008–2019, 124,978 cases of inguinal herniorrhaphy were identified: 100,880 (80.7%) OHR, 18,035 (14.4%) LHR, and 6063 (4.9%) RHR. Compared to LHR, RHR was associated with 4.94 times higher odds of complications, 100 min longer mean operative time, and 1.5 days longer median length of stay (LOS). Compared to OHR, RHR was associated with 5.92 times higher odds of complications, 57 min longer mean operative time, and 1.1 days longer median LOS. Utilization of RHR and LHR significantly increased over time. RHR complication rates decreased over time (2008: 20.8% to 2019: 3.2%) along with mean operative times (2008: 4.9 h to 2019: 2.8 h; p < 0.05).

Conclusion

While this study demonstrated inferior outcomes after RHR, the temporal trends are encouraging. This may be due to increased surgeon experience with robotics. Further prospective data will elucidate the role of RHR as this technique increases.

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Data availability

Data were obtained from Veterans Affairs Surgical Quality Improvement Database and used only for the purposes of this research.

Code availability

Statistical analysis was conducted with SAS version 9.4.

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Funding

No outside funding was received for this study.

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Authors and Affiliations

  1. Department of Surgery, Veterans Affairs Medical Center, 50 Irving St. NW, Washington, DC, 20422, USA

    T. J. Holleran, J. E. Duncan, M. Garrett & F. J. Brody

  2. Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA

    T. J. Holleran & M. A. Napolitano

  3. Department of Surgery, George Washington University Hospital, Washington, DC, USA

    M. A. Napolitano, A. D. Sparks & F. J. Brody

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  1. T. J. Holleran
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  3. A. D. Sparks
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  4. J. E. Duncan
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  5. M. Garrett
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  6. F. J. Brody
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Contributions

All authors contributed to study conception and design. Authors TH, MN, and AS contributed to the acquisition and analysis of data. All authors contributed to the interpretation of data. Authors TH, MN, AS, and FB contributed to drafting of the work while authors MG and JD made critical revisions. All authors read and approved the final manuscript and agree to be accountable for all aspects of work.

Corresponding author

Correspondence to F. J. Brody.

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Conflict of interest

Timothy Holleran, Michael Napolitano, Andrew Sparks, James Duncan, Meredith Garrett, and Fredrick Brody declare that they have no conflict of interest.

Ethical approval

Due to the retrospective nature of the study and utilization of de-identified data, Institutional Review Board (IRB) waiver of consent was applied and approved for this study (IRB-Exempt Protocol #01966).

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Holleran, T.J., Napolitano, M.A., Sparks, A.D. et al. Trends and outcomes of open, laparoscopic, and robotic inguinal hernia repair in the veterans affairs system. Hernia 26, 889–899 (2022). https://doi.org/10.1007/s10029-021-02419-3

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  • DOI: https://doi.org/10.1007/s10029-021-02419-3

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