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Comparative perioperative and 5-year outcomes of robotic and laparoscopic or open inguinal hernia repair: a study of 153,727 patients in the state of New York

  • 2020 SAGES Poster
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Objective

This study aimed to examine the perioperative outcomes of robotic inguinal hernia repair as compared to the open and laparoscopic approaches utilizing large-scale population-level data.

Methods

This study was funded by the SAGES Robotic Surgery Research Grant (2019). The New York Statewide Planning and Research Cooperative System (SPARCS) administrative database was used to identify all adult patients undergoing initial open (O-IHR), laparoscopic (L-IHR), and robotic (R-IHR) inguinal hernia repair between 2010 and 2016. Perioperative outcome measures [complications, length of stay (LOS), 30-day emergency department (ED) visits, 30-day readmissions] and estimated 1/3/5-year recurrence incidences were compared. Propensity score (PS) analysis was used to estimate marginal differences between R-IHR and L-IHR or O-IHR, using a 1:1 matching algorithm.

Results

During the study period, a total of 153,727 patients underwent inguinal hernia repair (117,603 [76.5%] O-IHR, 35,565 [23.1%] L-IHR; 559 [0.36%] R-IHR) in New York state. Initial univariate analysis found R-IHR to have longer LOS (1.74 days vs. 0.66 O-IHR vs 0.19 L-IHR) and higher rates of overall complications (9.3% vs. 3.6% O-IHR vs 1.1% L-IHR), 30-day ED visits (11.6% vs. 6.1% O-IHR vs. 4.9% L-IHR), and 30-day readmissions (5.6% vs. 2.4% O-IHR vs. 1.2% L-IHR) (p < 0.0001). R-IHR was associated with higher recurrence compared to L-IHR. Following PS analysis, there were no differences in perioperative outcomes between R-IHR and L-IHR, and the difference in recurrence was found to be sensitive to possible unobserved confounding factors. R-IHR had significantly lower risk of complications (Risk difference − 0.09, 95% CI [− 0.13, − 0.056]; p < 0.0001) and shorter LOS (Ratio 0.53, 95% CI [0.45, 0.62]; p < 0.0001) compared to O-IHR.

Conclusion

In adult patients, R-IHR may be associated with comparable to more favorable 30-day perioperative outcomes as compared with L-IHR and O-IHR, respectively.

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References

  1. Bittner R, Schwarz J (2012) Inguinal hernia repair: current surgical techniques. Langenbeck Arch Surg 397(2):271–282

    Article  CAS  Google Scholar 

  2. Poelman MM, van Heuvel B, Deelder JD, Abis GSA, Beudeker N, Bittner RR, Campanelli G, van Dam D, Dwars BJ, Eker HH, Fingerhut A, Khatkov I, Koeckerling F, Kukleta JF, Miserez M, Montogmery A, Munoz Brands RM, Morales Conde S (2013) EAES Consensus Development Conference on endoscopic repair of groin hernias. Surg Endosc 27(10):3505–3519

    Article  CAS  Google Scholar 

  3. Finley DS, Rodriguez E Jr, Ahlering TE (2007) Combined inguinal hernia repair with prosthetic mesh during transperitoneal robot assisted laparoscopic radical prostatectomy: a 4-year experience. J Urol 178(4):1296–1300

    Article  Google Scholar 

  4. Ito F, Jarrard D, Gould JC (2008) Transabdominal preperitoneal robotic inguinal hernia repair. J Laparoendosc Adv Surg Tech 18(3):397–399

    Article  Google Scholar 

  5. Sheetz KH, Claflin J, Dimick JB (2020) Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open 3(1):e1918911

    Article  Google Scholar 

  6. Childers CP, Maggard-Gibbons M (2018) Estimation of the acquisition and operating costs for robotic surgery. JAMA 320(8):835–836

    Article  Google Scholar 

  7. Coviello V, Boggess M (2004) Cumulative incidence estimation in the presence of competing risks. Stata J 4(2):103–112

    Article  Google Scholar 

  8. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrene Earlbaum Associates, Lawrence

    Google Scholar 

  9. Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 1:41–55

    Article  Google Scholar 

  10. Rosenbaum PR (2007) Sensitivity analysis for m-estimates, tests, and confidence intervals in matched observational studies. Biometrics 63(2):456–464

    Article  CAS  Google Scholar 

  11. Everitt B, Howell DC (2005) Encyclopedia of statistics in behavioral science. Wiley, Hoboken

    Book  Google Scholar 

  12. Rosenbaum PR (2002) Observational studies. Springer, New York

    Book  Google Scholar 

  13. Huerta S, Timmerman C, Argo M, Favela J, Pham T, Kukreja S, Yan J, Zhu H (2019) Open, laparoscopic, and robotic inguinal hernia repair: outcomes and predictors of complications. J Surg Res 241:119–127

    Article  Google Scholar 

  14. Aiolfi A, Cavalli M, Micheletto G, Lombardo F, Bonitta G, Morlacchi A, Bruni PG, Campanelli G, Bona D (2019) Primary inguinal hernia: systematic review and Bayesian network meta-analysis comparing open, laparoscopic transabdominal preperitoneal, totally extraperitoneal, and robotic preperitoneal repair. Hernia 23(3):473–484

    Article  CAS  Google Scholar 

  15. Tam V, Rogers DE, Al-Abbas A, Borrebach J, Dunn SA, Zureikat AH, Zeh HJ, Hogg ME (2019) Robotic inguinal hernia repair: a large health system’s experience with the first 300 cases and review of the literature. J Surg Res 235:98–104

    Article  Google Scholar 

  16. Bittner Iv JG, Cesnik LW, Kirwan T, Wolf L, Guo D (2018) Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches [published correction appears in J Robot Surg. 2018 Jun 18]. J Robot Surg. 12(4):625–632

    Article  Google Scholar 

  17. Prabhu AS, Carbonell A, Hope W, Warren J, Higgins R, Jacob B, Blatnik J, Haskins I, Alkhatib H, Tastaldi L, Fafaj A, Tu C, Rosen MJ (2020) Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair: The RIVAL Randomized Clinical Trial. JAMA Surg 155(5):380–387

    Article  Google Scholar 

  18. Charles EJ, Mehaffe JH, Tache-Leon CA, Hallowell PT, Sawyer RG, Yang Z (2018) Inguinal hernia repair: is there a benefit to using the robot? Surg Endosc 32:2131–2136

    Article  Google Scholar 

  19. Pokala B, Armijo PR, Flore L, Hennings D, Oleynikov D (2019) Minimally invasive inguinal hernia repair is superior to open: a national database review. Hernia 23:593–599

    Article  CAS  Google Scholar 

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Acknowledgements

We acknowledge the biostatistical consultation and support provided by the Biostatistical Consulting Core at the Stony Brook University School of Medicine. We would like to thank the SAGES Research and Career Development Committee for their support and funding.

Funding

This study was funded by the 2019 SAGES Robotic Surgery Research Grant.

Author information

Authors and Affiliations

  1. Department of Surgery, Thomas Jefferson University, 211 S 9th Street, Suite 402, Philadelphia, PA, 19107, USA

    Talar Tatarian & Connor McPartland

  2. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA

    Lizhou Nie

  3. Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA

    Andrew M. Brown, Konstantinos Spaniolas, Salvatore Docimo & Aurora D. Pryor

  4. Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA

    Jie Yang

  5. Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA

    Maria S. Altieri

Authors
  1. Talar Tatarian
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  2. Lizhou Nie
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  3. Connor McPartland
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  4. Andrew M. Brown
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  7. Konstantinos Spaniolas
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  8. Salvatore Docimo
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  9. Aurora D. Pryor
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Corresponding author

Correspondence to Talar Tatarian.

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Disclosures

Konstantinos Spaniolas reports grants from Merck, and is a speaker for Gore outside the submitted work. Aurora D. Pryor reports personal fees from Ethicon, Gore, Merck, Medtronic, and Stryker, grants and personal fees from Obalon, grants from Baronova, outside the submitted work. Talar Tatarian, Connor McPartland, Andrew M Brown, Jie Yang, Lizhou Nie, Maria S. Altieri, and Salvatore Docimo declare that they have no conflict of interest.

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Accepted as a Quickshot Presentation and ePoster at the SAGES 2020 Annual Meeting.

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Tatarian, T., Nie, L., McPartland, C. et al. Comparative perioperative and 5-year outcomes of robotic and laparoscopic or open inguinal hernia repair: a study of 153,727 patients in the state of New York. Surg Endosc 35, 7209–7218 (2021). https://doi.org/10.1007/s00464-020-08211-1

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  • DOI: https://doi.org/10.1007/s00464-020-08211-1

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