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Predictors of laparoscopic versus open inguinal hernia repair

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Abstract

Background

Inguinal hernia repair (IHR) is among the most common general surgery procedures. Multiple studies have examined costs and benefits of laparoscopic approach versus open repair. This study aimed to identify patient, surgeon, and hospital demographic predictors of laparoscopic versus open IHR.

Methods

We conducted a retrospective analysis of 342,814 IHRs (241,669 open; 101,145 laparoscopic) performed in adults (age ≥ 18) from 2010 to 2015 using the Premier Hospital Database. Multivariate logistic regression was used to estimate the adjusted odds ratio of an IHR being laparoscopic versus open with respect to several demographic variables.

Results

The odds of an IHR being laparoscopic increased from 2010 to 2015. A laparoscopic procedure was more likely in patients who were < age 65 (OR 1.29, CI 1.24–1.31, p < 0.0001), male (OR 1.31, CI 1.27–1.34, p < 0.0001), privately insured (OR 1.36, CI 1.33–1.40, p < 0.0001), and neither white, black, nor Hispanic (OR 1.11, CI 1.09–1.14, p < 0.0001). The likelihood of a procedure being laparoscopic decreased 13% with each one-unit increase in Charlson comorbidity index value (OR 0.88, CI 0.87–0.89, p < 0.0001). Surgeons were more likely to perform a laparoscopic procedure if they had larger annual IHR caseloads (≥ 45/year; OR 1.57, CI 1.53–1.60, p < 0.0001), and operated at large hospitals (> 500 beds; OR 1.36, CI 1.33–1.39, p < 0.0001) in New England (OR 2.38, CI 2.29–2.47, p < 0.0001). Non-predictors of a laparoscopic procedure included urban/rural hospital location (OR 1.02, CI 0.10–1.05, p = 0.06) and hospital teaching status (OR 1.01, CI 0.99–1.03, p = 0.2084).

Conclusions

Use of laparoscopic IHR is increasing. Patient age, gender, race, and insurance type, as well as surgeon annual volume, hospital size, and hospital region were predictors of a laparoscopic procedure. Further studies are needed to explain and remedy underlying differences impacting these predictors.

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Acknowledgements

The authors thank Medtronic, Inc. for their donation of the data used for this study.

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Authors and Affiliations

  1. John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA

    K. Keano Pavlosky

  2. Department of Surgery, John A. Burns School of Medicine, University of Hawaii, 1356 Lusitana St., Sixth Floor, Honolulu, HI, 96813, USA

    John D. Vossler, Kenric M. Murayama & Dean J. Mikami

  3. Loyola University, Chicago, IL, USA

    Sarah M. Murayama

  4. Medtronic Healthcare Economics Outcomes Research Division, New Haven, CT, USA

    Marilyn A. Moucharite

Authors
  1. K. Keano Pavlosky
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  2. John D. Vossler
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  3. Sarah M. Murayama
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  4. Marilyn A. Moucharite
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  5. Kenric M. Murayama
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  6. Dean J. Mikami
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Corresponding author

Correspondence to Dean J. Mikami.

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Disclosures

Data from the Premier Hospital Database was purchased by Medtronic, Inc. and donated for use in this research project. K. Keano Pavlosky, John D. Vossler, Sarah M. Murayama, Kenric M. Murayama have no conflict of interest or financial ties to disclose. Marilyn A. Moucharite: Employed by Medtronic, Inc. Dean J. Mikami: Consultant for Medtronic, Inc.

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Pavlosky, K.K., Vossler, J.D., Murayama, S.M. et al. Predictors of laparoscopic versus open inguinal hernia repair. Surg Endosc 33, 2612–2619 (2019). https://doi.org/10.1007/s00464-018-6557-6

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  • DOI: https://doi.org/10.1007/s00464-018-6557-6

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