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Differences in in-hospital outcomes and healthcare utilization for laparoscopic versus open approach for emergency inguinal hernia repair: a nationwide analysis

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Abstract

Purpose

There has been a growing debate of whether laparoscopic or open surgical techniques are superior for inguinal hernia repair. For incarcerated and strangulated inguinal hernias, the laparoscopic approach remains controversial. This study aims to be the first nationwide analysis to compare clinical and healthcare utilization outcomes between laparoscopic and open inguinal hernia repair in an emergency setting.

Methods

A retrospective analysis of the National Inpatient Sample was performed. All patients who underwent laparoscopic inguinal hernia repair (LIHR) and open inguinal hernia repair (OIHR) between October 2015 and December 2019 were included. The primary outcome was mortality, and secondary outcomes include post-operative complications, ICU admission, length of stay (LOS), and total admission cost. Two approaches were compared using univariate and multivariate logistic and linear regression.

Results

Between the years 2015 and 2019, 17,205 patients were included. Among these, 213 patients underwent LIHR and 16,992 underwent OIHR. No difference was observed between laparoscopic and open repair for mortality (odds ratio [OR] 0.80, 95% CI [0.25, 2.61], p = 0.714). Additionally, there was no significant difference between groups for post-operative ICU admission (OR 1.11, 95% CI [0.74, 1.67], p = 0.614), post-operative complications (OR 1.09, 95% CI [0.76, 1.56], p = 0.647), LOS (mean difference [MD]: -0.02 days, 95% CI [− 0.56, 0.52], p = 0.934), or total admission cost (MD: $3,028.29, 95% CI [$− 110.94, $6167.53], p = 0.059).

Conclusion

Laparoscopic inguinal hernia repair is comparable to the open inguinal hernia repair with respect to low rates of morbidity, mortality as well as healthcare resource utilization.

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Data availability statement

Data will be made available upon request.

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Authors and Affiliations

  1. Division of General Surgery, McMaster University, Hamilton, ON, Canada

    Y. Lee, L. Tessier, D. Zhao, Y. Samarasinghe, A. Doumouras, F. Saleh & D. Hong

  2. Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA

    Y. Lee

  3. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    L. Tessier

  4. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    A. Jong

  5. Division of General Surgery, Department of Surgery, William Osler Health System, Brampton, ON, Canada

    F. Saleh

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Correspondence to D. Hong.

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Nothing to disclose.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval was given by the Hamilton Integrated Research Ethics Board (HiREB).

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This research was based on data derived from medical records and thus included human participants. As such, it complied to all ethical standards.

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The data used in this study was taken from the National Inpatient Sample database. As this repository only supplies deindentified data, informed consent could not be obtained.

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Lee, Y., Tessier, L., Jong, A. et al. Differences in in-hospital outcomes and healthcare utilization for laparoscopic versus open approach for emergency inguinal hernia repair: a nationwide analysis. Hernia 27, 601–608 (2023). https://doi.org/10.1007/s10029-023-02742-x

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