Minimally invasive inguinal hernia repair is superior to open: a national database review

B. Pokala, P. R. Armijo, L. Flores, D. Hennings, D. Oleynikov

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: Many publications have focused on single-surgeon or single-center data, comparing surgical approach in inguinal hernia repair. This study evaluated outcomes in patients who underwent open (OIHR), laparoscopic (LIHR) or robotic (RIHR) inguinal hernia repair using a national database. Methods: The Vizient clinical database was queried using ICD-9 and ICD-10 procedure and diagnosis codes for RIHR, LIHR, and OIHR from 2013 to 2017. Elective procedures classified as minor or moderate risk severity were included. Complications, 30-day readmission, mortality, LOS, and intra-hospital opiate utilization were analyzed using IBM SPSS v.23.0. Results: 3547 patients (OIHR: N = 2413, LIHR: N = 540, RIHR: N = 594) were included in the study. Majority were male (OIHR 84.1%, LIHR 80.4%, RIHR 95.3%), ≥ 51 years (OIHR 81.5%, LIHR 81.7%, RIHR 95.3%), and Caucasian (OIHR 75.7%, LIHR 77.0%, RIHR 81.5%). RIHR had the least overall complications (0.67%) compared to LIHR (4.44%) and OIHR (3.85%), p < 0.05. OIHR had the highest postoperative infection rate (8.33%), versus LIHR (0.56%) and RIHR (0.0%), p < 0.05. OIHR had longer length of stay (3.57 ± 4.1 days) when compared to both groups (LIHR 2.2 ± 2.13 days, RIHR 1.75 ± 1.62 days), p < 0.001. OIHR had higher 30-day readmission rates (3.61%) compared to RIHR (0.84%), p = 0.001. Mortality was similar between groups (OIHR 0.21%, LIHR 0.19%, RIHR 0.17%), p = 0.081. Opiate use was higher with OIHR (96.0%), compared to both LIHR (93.1%), and RIHR (93.8%), p = 0.004. Conclusion: RIHR outcomes were improved compared to OIHR or LIHR. OIHR had the highest rate of opiate use, there was no difference between LIHR and RIHR. Further studies are needed to determine the role of RIHR and to assess whether surgeon or patient selection contributes to outcomes.

Original languageEnglish (US)
Pages (from-to)593-599
Number of pages7
JournalHernia
Volume23
Issue number3
DOIs
StatePublished - Jun 1 2019

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Opiate Alkaloids
Inguinal Hernia
Herniorrhaphy
International Classification of Diseases
Databases
Mortality
Robotics
Patient Selection
Publications
Length of Stay
Outcome Assessment (Health Care)
Infection
Surgeons

Keywords

  • Cost
  • Inguinal hernia
  • Minimally invasive surgery
  • Open surgery
  • Opiate use
  • Outcomes

ASJC Scopus subject areas

  • Surgery

Cite this

Pokala, B., Armijo, P. R., Flores, L., Hennings, D., & Oleynikov, D. (2019). Minimally invasive inguinal hernia repair is superior to open: a national database review. Hernia, 23(3), 593-599. https://doi.org/10.1007/s10029-019-01934-8

Minimally invasive inguinal hernia repair is superior to open : a national database review. / Pokala, B.; Armijo, P. R.; Flores, L.; Hennings, D.; Oleynikov, D.

In: Hernia, Vol. 23, No. 3, 01.06.2019, p. 593-599.

Research output: Contribution to journalArticle

Pokala, B, Armijo, PR, Flores, L, Hennings, D & Oleynikov, D 2019, 'Minimally invasive inguinal hernia repair is superior to open: a national database review', Hernia, vol. 23, no. 3, pp. 593-599. https://doi.org/10.1007/s10029-019-01934-8
Pokala, B. ; Armijo, P. R. ; Flores, L. ; Hennings, D. ; Oleynikov, D. / Minimally invasive inguinal hernia repair is superior to open : a national database review. In: Hernia. 2019 ; Vol. 23, No. 3. pp. 593-599.
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title = "Minimally invasive inguinal hernia repair is superior to open: a national database review",
abstract = "Purpose: Many publications have focused on single-surgeon or single-center data, comparing surgical approach in inguinal hernia repair. This study evaluated outcomes in patients who underwent open (OIHR), laparoscopic (LIHR) or robotic (RIHR) inguinal hernia repair using a national database. Methods: The Vizient clinical database was queried using ICD-9 and ICD-10 procedure and diagnosis codes for RIHR, LIHR, and OIHR from 2013 to 2017. Elective procedures classified as minor or moderate risk severity were included. Complications, 30-day readmission, mortality, LOS, and intra-hospital opiate utilization were analyzed using IBM SPSS v.23.0. Results: 3547 patients (OIHR: N = 2413, LIHR: N = 540, RIHR: N = 594) were included in the study. Majority were male (OIHR 84.1{\%}, LIHR 80.4{\%}, RIHR 95.3{\%}), ≥ 51 years (OIHR 81.5{\%}, LIHR 81.7{\%}, RIHR 95.3{\%}), and Caucasian (OIHR 75.7{\%}, LIHR 77.0{\%}, RIHR 81.5{\%}). RIHR had the least overall complications (0.67{\%}) compared to LIHR (4.44{\%}) and OIHR (3.85{\%}), p < 0.05. OIHR had the highest postoperative infection rate (8.33{\%}), versus LIHR (0.56{\%}) and RIHR (0.0{\%}), p < 0.05. OIHR had longer length of stay (3.57 ± 4.1 days) when compared to both groups (LIHR 2.2 ± 2.13 days, RIHR 1.75 ± 1.62 days), p < 0.001. OIHR had higher 30-day readmission rates (3.61{\%}) compared to RIHR (0.84{\%}), p = 0.001. Mortality was similar between groups (OIHR 0.21{\%}, LIHR 0.19{\%}, RIHR 0.17{\%}), p = 0.081. Opiate use was higher with OIHR (96.0{\%}), compared to both LIHR (93.1{\%}), and RIHR (93.8{\%}), p = 0.004. Conclusion: RIHR outcomes were improved compared to OIHR or LIHR. OIHR had the highest rate of opiate use, there was no difference between LIHR and RIHR. Further studies are needed to determine the role of RIHR and to assess whether surgeon or patient selection contributes to outcomes.",
keywords = "Cost, Inguinal hernia, Minimally invasive surgery, Open surgery, Opiate use, Outcomes",
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T1 - Minimally invasive inguinal hernia repair is superior to open

T2 - a national database review

AU - Pokala, B.

AU - Armijo, P. R.

AU - Flores, L.

AU - Hennings, D.

AU - Oleynikov, D.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Purpose: Many publications have focused on single-surgeon or single-center data, comparing surgical approach in inguinal hernia repair. This study evaluated outcomes in patients who underwent open (OIHR), laparoscopic (LIHR) or robotic (RIHR) inguinal hernia repair using a national database. Methods: The Vizient clinical database was queried using ICD-9 and ICD-10 procedure and diagnosis codes for RIHR, LIHR, and OIHR from 2013 to 2017. Elective procedures classified as minor or moderate risk severity were included. Complications, 30-day readmission, mortality, LOS, and intra-hospital opiate utilization were analyzed using IBM SPSS v.23.0. Results: 3547 patients (OIHR: N = 2413, LIHR: N = 540, RIHR: N = 594) were included in the study. Majority were male (OIHR 84.1%, LIHR 80.4%, RIHR 95.3%), ≥ 51 years (OIHR 81.5%, LIHR 81.7%, RIHR 95.3%), and Caucasian (OIHR 75.7%, LIHR 77.0%, RIHR 81.5%). RIHR had the least overall complications (0.67%) compared to LIHR (4.44%) and OIHR (3.85%), p < 0.05. OIHR had the highest postoperative infection rate (8.33%), versus LIHR (0.56%) and RIHR (0.0%), p < 0.05. OIHR had longer length of stay (3.57 ± 4.1 days) when compared to both groups (LIHR 2.2 ± 2.13 days, RIHR 1.75 ± 1.62 days), p < 0.001. OIHR had higher 30-day readmission rates (3.61%) compared to RIHR (0.84%), p = 0.001. Mortality was similar between groups (OIHR 0.21%, LIHR 0.19%, RIHR 0.17%), p = 0.081. Opiate use was higher with OIHR (96.0%), compared to both LIHR (93.1%), and RIHR (93.8%), p = 0.004. Conclusion: RIHR outcomes were improved compared to OIHR or LIHR. OIHR had the highest rate of opiate use, there was no difference between LIHR and RIHR. Further studies are needed to determine the role of RIHR and to assess whether surgeon or patient selection contributes to outcomes.

AB - Purpose: Many publications have focused on single-surgeon or single-center data, comparing surgical approach in inguinal hernia repair. This study evaluated outcomes in patients who underwent open (OIHR), laparoscopic (LIHR) or robotic (RIHR) inguinal hernia repair using a national database. Methods: The Vizient clinical database was queried using ICD-9 and ICD-10 procedure and diagnosis codes for RIHR, LIHR, and OIHR from 2013 to 2017. Elective procedures classified as minor or moderate risk severity were included. Complications, 30-day readmission, mortality, LOS, and intra-hospital opiate utilization were analyzed using IBM SPSS v.23.0. Results: 3547 patients (OIHR: N = 2413, LIHR: N = 540, RIHR: N = 594) were included in the study. Majority were male (OIHR 84.1%, LIHR 80.4%, RIHR 95.3%), ≥ 51 years (OIHR 81.5%, LIHR 81.7%, RIHR 95.3%), and Caucasian (OIHR 75.7%, LIHR 77.0%, RIHR 81.5%). RIHR had the least overall complications (0.67%) compared to LIHR (4.44%) and OIHR (3.85%), p < 0.05. OIHR had the highest postoperative infection rate (8.33%), versus LIHR (0.56%) and RIHR (0.0%), p < 0.05. OIHR had longer length of stay (3.57 ± 4.1 days) when compared to both groups (LIHR 2.2 ± 2.13 days, RIHR 1.75 ± 1.62 days), p < 0.001. OIHR had higher 30-day readmission rates (3.61%) compared to RIHR (0.84%), p = 0.001. Mortality was similar between groups (OIHR 0.21%, LIHR 0.19%, RIHR 0.17%), p = 0.081. Opiate use was higher with OIHR (96.0%), compared to both LIHR (93.1%), and RIHR (93.8%), p = 0.004. Conclusion: RIHR outcomes were improved compared to OIHR or LIHR. OIHR had the highest rate of opiate use, there was no difference between LIHR and RIHR. Further studies are needed to determine the role of RIHR and to assess whether surgeon or patient selection contributes to outcomes.

KW - Cost

KW - Inguinal hernia

KW - Minimally invasive surgery

KW - Open surgery

KW - Opiate use

KW - Outcomes

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