This study compares the impact of open (OIHR) versus laparoscopic (LIHR) inguinal hernia repair on healthcare spending and postoperative outcomes.
The TRUVEN database was queried using ICD9 procedure codes for open, laparoscopic, and robotic-assisted IHR, from 2012 to 2013. Patients > 18 years of age and continuously enrolled for 12 months postoperatively were included. Demographics, patient comorbidities, postoperative complications, pain medication use, length of hospital stay, missed work hours, postoperative visits, and overall expenditure were collected, and assessed at time of surgery and at 30-, 60-, 90-, 180-, and 365-days postoperatively. Statistical analysis was conducted using SAS, with α = 0.05.
66,116 patients were included (LIHR: N = 23,010; OIHR: N = 43,106). Robotic-assisted procedures were excluded due to small sample size (N = 61). The largest demographic was males between 55 and 64 years. LIHR had fewer surgical wound complications than OIHR (LIHR: 0.3%; OIHR: 0.5%, p = 0.007), less utilization of pain medication (LIHR: 23.3%; OIHR: 28.5%; p < 0.001), and fewer outpatient visits. In the 90-day postoperative period, LIHR had significantly fewer missed work hours (LIHR: 12.1 ± 23.2 h; OIHR: 12.9 ± 26.7 h, p = 0.023). LIHR had higher postoperative urinary complications (LIHR: 0.2%; OIHR: 0.1%; p < 0.001), consistent with the current literature. LIHR expenditures ($15,030 ± $25,906) were higher than OIHR ($13,303 ± 32,014), p < 0.001.
The results highlight the benefits of laparoscopic repair with regard to surgical wound complications, postoperative pain, outpatient visits, and missed work hours. These improved outcomes with respect to overall healthcare spending and employee absenteeism support the paradigm shift toward laparoscopic inguinal hernia repairs, in spite of higher overall expenditures.
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HerniaSurge Group, Simons M, Smietanski M, Bonjer H, Bittner R, Miserez M, Aufenacker TJ, Chowbey P, Tran H, Sani R (2017) International guidelines for groin hernia management. Hernia 22:1–165
Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827
Ger R, Mishrick A, Hurwitz J, Romero C, Oddsen R (1993) Management of groin hernias by laparoscopy. World J Surg 17:46–50
McCormack K, Scott N, Go PM, Ross SJ, Grant A (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. The Cochrane Library
Wellwood J, Sculpher MJ, Stoker D, Nicholls GJ, Geddes C, Whitehead A, Singh R, Spiegelhalter D (1998) Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost. BMJ 317:103–110
Abbas AE, Ellatif MEA, Noaman N, Negm A, El-Morsy G, Amin M, Moatamed A (2012) Patient-perspective quality of life after laparoscopic and open hernia repair: a controlled randomized trial. Surg Endosc 26:2465–2470
Liem MS, Halsema JA, van der Graaf Y, Schrijvers AJ, van Vroonhoven TJ (1997) Cost-effectiveness of extraperitoneal laparoscopic inguinal hernia repair: a randomized comparison with conventional herniorrhaphy. Coala trial group Ann Surg 226:668–675, discussion 675–6
Butters M, Redecke J, Köninger J (2007) Long-term results of a randomized clinical trial of Shouldice, Lichtenstein and transabdominal preperitoneal hernia repairs. Br J Surg 94:562–565
Elhendawy AO, Abd-Raboh OH, Ismail TA, Nagy AA (2018) Randomized comparative study between laparoscopic transabdominal pre-peritoneal versus totally extraperitoneal approach in inguinal hernia repair. Age (in years) 1:0–110
Tadaki C, Lomelin D, Simorov A, Jones R, Humphreys M, DaSilva M, Choudhury S, Shostrom V, Boilesen E, Kothari V, Oleynikov D, Goede M (2016) Perioperative outcomes and costs of laparoscopic versus open inguinal hernia repair. Hernia 20:1–6
Poobalan AS, Bruce J, Smith WCS, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54
Employer Cost for Employee Compensation, National Compensation Survey. United States Bureau of Labor Statistics. March 2004–June 2017. www.bls.gov/eci/
Dr. Oleynikov declares conflict of interest directly related to the submitted work, having received a research grant support from Medtronic; not directly related to the submitted work, he is the stock holder of Virtual Incision Corporation. Dr. Rana, Dr. Armijo, Mr. Khan, Dr. Bills, Ms. Morien, and Dr. Zhang have no conflicts of interest or financial ties to disclose.
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Rana, G., Armijo, P.R., Khan, S. et al. Outcomes and impact of laparoscopic inguinal hernia repair versus open inguinal hernia repair on healthcare spending and employee absenteeism. Surg Endosc 34, 821–828 (2020). https://doi.org/10.1007/s00464-019-06835-6
- Laparoscopic inguinal hernia repair
- Open inguinal hernia repair
- Postoperative outcomes
- Cost analysis
- Healthcare costs