Skip to main content
SpringerLink
Log in

Laparoscopic versus open hernia repair: outcomes and sociodemographic utilization results from the nationwide inpatient sample

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

The differences and advantages of laparoscopic (LVHR) and open ventral hernia repair (OVHR) have been debated since laparoscopic hernia repair was first described. The purpose of this study is to compare LVHR and OVHR with mesh in the United States using the Nationwide Inpatient Sample (NIS).

Methods

The NIS, a representative sample of approximately 20 % of all inpatient encounters in the United States, was queried for all ventral hernia repairs with graft or prosthesis in 2009 using ICD-9-CM codes. The patients were stratified into LVHR and OVHR groups. Sociodemographic data, comorbidities, complications, and outcomes were compared between groups.

Results

A total of 18,223 cases were documented in the NIS sample after inclusion and exclusion criteria were met. LVHR was performed in 27.6 % of cases. There were no statistically significant differences in gender or mean income by zip code of residence. Mean age (58.8 years in open group vs. 58.1 years, p = 0.014) and mean Charlson score (0.97 vs. 0.77, p < 0.0001) differed significantly between groups. OVHR more often was associated with emergent admissions (21.7 vs. 15.2 %, p < 0.0001). There were significant differences comparing outcomes between groups: complication rate (OVHR: 8.24 vs. LVHR: 3.97 %, p < 0.0001), average length of stay (5.2 vs. 3.5 days, p < 0.0001), total charge ($45,708 vs. $35,947, p < 0.0001), frequency of routine discharge (80.8 vs. 91.1 %, p < 0.0001), and mortality rate (0.88 vs. 0.36 %, p = 0.0002). After controlling for confounding variables with multivariate regression, all outcomes remained significant between groups.

Conclusions

Patients who have undergone LVHR with mesh had fewer complications, shorter length of stay, lower hospital charges, more frequent routine discharge, and decreased mortality compared with those who received open repair. Patient comorbidities, selection bias, and emergency operations may limit the number of patients who receive laparoscopic ventral hernia repair. Regionalization studies may better illuminate the low rates of laparoscopic surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183

    Article  CAS  PubMed  Google Scholar 

  2. LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41

    CAS  PubMed  Google Scholar 

  3. Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399 (discussion 399–400)

    PubMed  Google Scholar 

  4. Pierce RA, Spitler JA, Frisella MM, Matthews BD, Brunt LM (2007) Pooled data analysis of laparoscopic vs. open ventral hernia repair: 14 years of patient data accrual. Surg Endosc 21:378–386

    Article  PubMed  Google Scholar 

  5. Lomanto D, Iyer SG, Shabbir A, Cheah WK (2006) Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc 20:1030–1035

    Article  CAS  PubMed  Google Scholar 

  6. Olmi S, Scaini A, Cesana GC, Erba L, Croce E (2007) Laparoscopic versus open incisional hernia repair: an open randomized controlled study. Surg Endosc 21:555–559

    Article  CAS  PubMed  Google Scholar 

  7. McGreevy JM, Goodney PP, Birkmeyer CM, Finlayson SR, Laycock WS, Birkmeyer JD (2003) A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs. Surg Endosc 17:1778–1780

    Article  CAS  PubMed  Google Scholar 

  8. Beldi G, Ipaktchi R, Wagner M, Gloor B, Candinas D (2006) Laparoscopic ventral hernia repair is safe and cost effective. Surg Endosc 20:92–95

    Article  CAS  PubMed  Google Scholar 

  9. Earle D, Seymour N, Fellinger E, Perez A (2006) Laparoscopic versus open incisional hernia repair: a single-institution analysis of hospital resource utilization for 884 consecutive cases. Surg Endosc 20:71–75

    Article  CAS  PubMed  Google Scholar 

  10. Goodney PP, Birkmeyer CM, Birkmeyer JD (2002) Short-term outcomes of laparoscopic and open ventral hernia repair: a meta-analysis. Arch Surg 137:1161–1165

    Article  PubMed  Google Scholar 

  11. Bingener J, Buck L, Richards M, Michalek J, Schwesinger W, Sirinek K (2007) Long-term outcomes in laparoscopic vs open ventral hernia repair. Arch Surg 142:562–567

    Article  PubMed  Google Scholar 

  12. Kurmann A, Visth E, Candinas D, Beldi G (2011) Long-term follow-up of open and laparoscopic repair of large incisional hernias. World J Surg 35:297–301

    Article  PubMed  Google Scholar 

  13. Heniford BT, Park A, Ramshaw BJ, Voeller G (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190:645–650

    Article  CAS  PubMed  Google Scholar 

  14. Kirshtein B, Lantsberg L, Avinoach E, Bayme M, Mizrahi S (2002) Laparoscopic repair of large incisional hernias. Surg Endosc 16:1717–1719

    Article  CAS  PubMed  Google Scholar 

  15. LeBlanc KA, Whitaker JM (2002) Management of chronic postoperative pain following incisional hernia repair with Composix mesh: a report of two cases. Hernia 6:194–197

    Article  CAS  PubMed  Google Scholar 

  16. Parker HH 3rd, Nottingham JM, Bynoe RP, Yost MJ (2002) Laparoscopic repair of large incisional hernias. Am Surg 68:530–533 (discussion 533–534)

    PubMed  Google Scholar 

  17. Rosen M, Brody F, Ponsky J, Walsh RM, Rosenblatt S, Duperier F, Fanning A, Siperstein A (2003) Recurrence after laparoscopic ventral hernia repair. Surg Endosc 17:123–128

    Article  CAS  PubMed  Google Scholar 

  18. Pring CM, Tran V, O’Rourke N, Martin IJ (2008) Laparoscopic versus open ventral hernia repair: a randomized controlled trial. ANZ J Surg 78:903–906

    Article  PubMed  Google Scholar 

  19. Asencio F, Aguilo J, Peiro S, Carbo J, Ferri R, Caro F, Ahmad M (2009) Open randomized clinical trial of laparoscopic versus open incisional hernia repair. Surg Endosc 23:1441–1448

    Article  PubMed  Google Scholar 

  20. Itani KM, Hur K, Kim LT, Anthony T, Berger DH, Reda D, Neumayer L (2010) Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg 145:322–328 (discussion 328)

    Article  PubMed  Google Scholar 

  21. Barbaros U, Asoglu O, Seven R, Erbil Y, Dinccag A, Deveci U, Ozarmagan S, Mercan S (2007) The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia 11:51–56

    Article  CAS  PubMed  Google Scholar 

  22. Misra MC, Bansal VK, Kulkarni MP, Pawar DK (2006) Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study. Surg Endosc 20:1839–1845

    Article  CAS  PubMed  Google Scholar 

  23. Navarra G, Musolino C, De Marco ML, Bartolotta M, Barbera A, Centorrino T (2007) Retromuscular sutured incisional hernia repair: a randomized controlled trial to compare open and laparoscopic approach. Surg Laparosc Endosc Percutan Tech 17:86–90

    Article  PubMed  Google Scholar 

  24. Cassar K, Munro A (2002) Surgical treatment of incisional hernia. Br J Surg 89:534–545

    Article  CAS  PubMed  Google Scholar 

  25. Hegamin AP (2001) International classification of diseases, 9th rev. Clinical modification, 6th edn. Medicode Publications, Salt Lake City

  26. HCUP Nationwide Inpatient Sample (NIS) (2009) Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 3 Apr 2012

  27. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  28. Quan H, Parsons GA, Ghali WA (2002) Validity of information on comorbidity derived rom ICD-9-CCM administrative data. Med Care 40:675–685

    Article  PubMed  Google Scholar 

  29. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619

    Article  CAS  PubMed  Google Scholar 

  30. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139

    Article  PubMed  Google Scholar 

  31. Romano PS, Roos LL, Jollis JG (1993) Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 46:1075–1079 (discussion 1081–1090)

    Article  CAS  PubMed  Google Scholar 

  32. D’Hoore W, Sicotte C, Tilquin C (1993) Risk adjustment in outcome assessment: the Charlson comorbidity index. Methods Inf Med 32:382–387

    PubMed  Google Scholar 

  33. D’Hoore W, Bouckaert A, Tilquin C (1996) Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol 49:1429–1433

    Article  PubMed  Google Scholar 

  34. HCUP Comorbidity Software version 3.7 (2012) Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp. Accessed 25 Feb 2012

  35. Wang YR, Dempsey DT, Richter JE (2011) Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993–2006. Dis Esophagus 24:215–223

    Article  CAS  PubMed  Google Scholar 

  36. Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kercher KW (2008) Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 206:638–644

    Article  PubMed  Google Scholar 

  37. Colavita PD, Tsirline VB, Belyansky I, Walters AL, Lincourt AE, Sing RF, Heniford BT (2012) Prospective, long-term comparison of quality of life in laparoscopic versus open ventral hernia repair. Ann Surg (in press)

  38. Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27

    Article  CAS  PubMed  Google Scholar 

  39. Dominick KL, Dudley TK, Coffman CJ, Bosworth HB (2005) Comparison of three comorbidity measures for predicting health service use in patients with osteoarthritis. Arthritis Rheum 53:666–672

    Article  PubMed  Google Scholar 

  40. Stukenborg GJ, Wagner DP, Connors AF Jr (2001) Comparison of the performance of two comorbidity measures, with and without information from prior hospitalizations. Med Care 39:727–739

    Article  CAS  PubMed  Google Scholar 

  41. Southern DA, Quan H, Ghali WA (2004) Comparison of the Elixhauser and Charlson/Deyo methods of comorbidity measurement in administrative data. Med Care 42:355–360

    Article  PubMed  Google Scholar 

  42. Quail JM, Lix LM, Osman BA, Teare GF (2011) Comparing comorbidity measures for predicting mortality and hospitalization in three population-based cohorts. BMC Health Serv Res 11:146

    Article  PubMed  Google Scholar 

  43. van Walraven C, Austin PC, Jennings A, Quan H, Forster AJ (2009) A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care 47:626–633

    Article  PubMed  Google Scholar 

Download references

Disclosures

Drs. Paul D. Colavita, Victor B. Tsirline, Igor Belyansky, Amy E. Lincourt, and Ms. Amanda L. Walters have no conflict of interest or financial ties to disclose. Dr. B. Todd Heniford has received grants from Ethicon, W.L. Gore and Associates, LifeCell, and Bard.

Author information

Authors and Affiliations

  1. Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA

    Paul D. Colavita, Victor B. Tsirline, Amanda L. Walters, Amy E. Lincourt, Igor Belyansky & B. Todd Heniford

Authors
  1. Paul D. Colavita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Victor B. Tsirline
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amanda L. Walters
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amy E. Lincourt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Igor Belyansky
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. Todd Heniford
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Todd Heniford.

Additional information

First Place Award in the 2012 SAGES Residents and Fellows Scientific Session, March 7–10, 2012, San Diego, CA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Colavita, P.D., Tsirline, V.B., Walters, A.L. et al. Laparoscopic versus open hernia repair: outcomes and sociodemographic utilization results from the nationwide inpatient sample. Surg Endosc 27, 109–117 (2013). https://doi.org/10.1007/s00464-012-2432-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2432-z

Keywords

Search

Navigation