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Comparison of hospital costs and length of stay associated with open-mesh, totally extraperitoneal inguinal hernia repair, and transabdominal preperitoneal inguinal hernia repair: An analysis of observational data using propensity score matching

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Abstract

Background

Laparoscopic inguinal hernia surgery is increasingly seen as the superior technique in hernia repair. Compared to open-mesh hernia repair, laparoscopic approaches are often reported to be more cost-effective but incur higher costs for the provider. The objective of this study was to analyze the effect of transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repair of nonincarcerated inguinal hernias in men on hospital costs and length of stay (LoS).

Methods

We used routine administrative, highly standardized, patient-level cost data from 15 German hospitals participating in the national cost data study. We compared TEP, TAPP, and open-mesh repair. We conducted propensity score matching to account for baseline differences between treatment groups and subsequently estimated the treatment effect on costs and LoS.

Results

Total costs for both TEP and TAPP surgery were significantly lower than those for open-mesh repair (p < 0.0001 and p < 0.05, respectively). TEP repair also had a slight but nonsignificant advantage in total costs compared to TAPP repair, while TAPP surgery was associated with a significantly shorter LoS than TEP (p < 0.001).

Conclusion

Results suggest that laparoscopic approaches in hernia repair are not necessarily associated with higher hospital resource consumption than open-mesh repair.

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Acknowledgments

This project was funded through the seventh framework program (FP7) of the European Commission under Grant Agreement No. 223300.

Disclosures

Prof. Dr. Reinhard Busse, David Scheller-Kreinsen, Julia Röttger, and Friedrich Wittenbecher have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Sekretariat H80, Straße des 17. Juni 135, 10623, Berlin, Germany

    Friedrich Wittenbecher, David Scheller-Kreinsen, Julia Röttger & Reinhard Busse

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  1. Friedrich Wittenbecher
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  2. David Scheller-Kreinsen
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  3. Julia Röttger
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  4. Reinhard Busse
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Corresponding author

Correspondence to Friedrich Wittenbecher.

Electronic supplementary material

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464_2012_2608_MOESM1_ESM.doc

Supplementary Table 1 Procedure per hospital, LoS = Length of stay; d = days; n = frequency; Open-mesh = open-mesh hernia repair; TAPP = transabdominal preperitoneal hernia repair; TEP = totally extraperitoneal hernia repair (DOC 64 kb)

464_2012_2608_MOESM2_ESM.doc

Supplementary Table 2 Standardized differences before and after matching: TEP vs. open-mesh, n = frequency; d = standardized differences; K40.9- = ICD-10GM code for unilateral nonincarcerated inguinal hernia; K40.2- = ICD-10GM code for bilateral nonincarcerated hernia; Open-mesh = open-mesh hernia repair; TEP = totally extraperitoneal hernia repair (DOC 64 kb)

464_2012_2608_MOESM3_ESM.doc

Supplementary Table 3 Standardized differences before and after matching: TAPP vs. open-mesh, n = frequency; d = standardized differences; K40.9- = ICD-10GM code for unilateral nonincarcerated inguinal hernia; K40.2- = ICD-10GM code for bilateral nonincarcerated hernia; Open-mesh = open-mesh hernia repair; TAPP = transabdominal preperitoneal hernia repair (DOC 67 kb)

464_2012_2608_MOESM4_ESM.doc

Supplementary Table 4 Standardized differences before and after matching: TEP vs. TAPP, n = frequency; d = standardized differences; K40.9- = ICD-10GM code for unilateral nonincarcerated inguinal hernia; K40.2- = ICD-10GM code for bilateral non-incarcerated hernia; TAPP = transabdominal preperitoneal hernia repair; TEP = totally extraperitoneal hernia repair (DOC 60 kb)

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Wittenbecher, F., Scheller-Kreinsen, D., Röttger, J. et al. Comparison of hospital costs and length of stay associated with open-mesh, totally extraperitoneal inguinal hernia repair, and transabdominal preperitoneal inguinal hernia repair: An analysis of observational data using propensity score matching. Surg Endosc 27, 1326–1333 (2013). https://doi.org/10.1007/s00464-012-2608-6

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  • DOI: https://doi.org/10.1007/s00464-012-2608-6

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