Robotic ventral hernia repair is not superior to laparoscopic

a national database review

Priscila Armijo, Akshay Pratap, Yi Wang, Valerie Shostrom, Dmitry Oleynikov

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Minimally invasive surgery (MIS) use for ventral hernia repair has increased over the last decade. Whether outcomes are improved by robotic assistance remains a subject of debate. The aim of this study is to evaluate outcomes (including cost, complications, length of stay (LOS), and pain medication utilization) in patients who underwent an open (OVHR), laparoscopic (LVHR), or robotic (RVHR) ventral hernia repair (VHR). Methods: The Vizient database was queried using ICD-9 procedure and diagnosis codes for patients who underwent VHR from January 2013 to September 2015. Complications, 30-day readmission, mortality, LOS, cost, and intra-hospital opiate utilization were analyzed using IBM SPSS v.23.0.0.0. Median tests with post hoc pairwise comparisons, Fischer’s exact, and Pearson’s chi-squared test with Bonferroni correction were applied where appropriate, with α = 0.05. Results: 46,799 patients (OVHR: N = 39,505, LVHR: N = 6829, RVHR: N = 465) met the criteria and patients in each group had similar demographics (Table 1). OVHR was associated with significant increased overall complications, 30-day readmission, LOS, and postoperative pain use compared to RVHR or LVHR. OVHR had higher mortality and postoperative infection rates than LVHR. RVHR had significantly higher rates of complications and postoperative infections compared to LVHR, although there was no difference in mortality, 30-day readmission, LOS, and postoperative pain medication use. Mean direct cost of surgery was significantly higher for RVHR, followed by OVHR and LVHR. Conclusions: Overall patient outcomes were improved in the LVHR and RVHR groups compared to the open approach. However, RVHR patients did not have significant improvement compared with the LVHR group in either short-term outcomes or opiate medication used. While RVHR surgery was the most expensive modality, OVHR was also significantly costlier than LVHR, which was the least expensive. Long-term data on recurrence could not be evaluated and should be studied to determine the role of robotic surgery in VHR and recurrence rates.

Original languageEnglish (US)
Pages (from-to)1834-1839
Number of pages6
JournalSurgical endoscopy
Volume32
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Ventral Hernia
Herniorrhaphy
Robotics
Databases
Opiate Alkaloids
Length of Stay
Postoperative Pain
Mortality
Costs and Cost Analysis
Recurrence
Minimally Invasive Surgical Procedures
Hospital Costs
International Classification of Diseases
Infection
Demography
Pain

Keywords

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

ASJC Scopus subject areas

  • Surgery

Cite this

Robotic ventral hernia repair is not superior to laparoscopic : a national database review. / Armijo, Priscila; Pratap, Akshay; Wang, Yi; Shostrom, Valerie; Oleynikov, Dmitry.

In: Surgical endoscopy, Vol. 32, No. 4, 01.04.2018, p. 1834-1839.

Research output: Contribution to journalArticle

Armijo, Priscila ; Pratap, Akshay ; Wang, Yi ; Shostrom, Valerie ; Oleynikov, Dmitry. / Robotic ventral hernia repair is not superior to laparoscopic : a national database review. In: Surgical endoscopy. 2018 ; Vol. 32, No. 4. pp. 1834-1839.
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abstract = "Background: Minimally invasive surgery (MIS) use for ventral hernia repair has increased over the last decade. Whether outcomes are improved by robotic assistance remains a subject of debate. The aim of this study is to evaluate outcomes (including cost, complications, length of stay (LOS), and pain medication utilization) in patients who underwent an open (OVHR), laparoscopic (LVHR), or robotic (RVHR) ventral hernia repair (VHR). Methods: The Vizient database was queried using ICD-9 procedure and diagnosis codes for patients who underwent VHR from January 2013 to September 2015. Complications, 30-day readmission, mortality, LOS, cost, and intra-hospital opiate utilization were analyzed using IBM SPSS v.23.0.0.0. Median tests with post hoc pairwise comparisons, Fischer’s exact, and Pearson’s chi-squared test with Bonferroni correction were applied where appropriate, with α = 0.05. Results: 46,799 patients (OVHR: N = 39,505, LVHR: N = 6829, RVHR: N = 465) met the criteria and patients in each group had similar demographics (Table 1). OVHR was associated with significant increased overall complications, 30-day readmission, LOS, and postoperative pain use compared to RVHR or LVHR. OVHR had higher mortality and postoperative infection rates than LVHR. RVHR had significantly higher rates of complications and postoperative infections compared to LVHR, although there was no difference in mortality, 30-day readmission, LOS, and postoperative pain medication use. Mean direct cost of surgery was significantly higher for RVHR, followed by OVHR and LVHR. Conclusions: Overall patient outcomes were improved in the LVHR and RVHR groups compared to the open approach. However, RVHR patients did not have significant improvement compared with the LVHR group in either short-term outcomes or opiate medication used. While RVHR surgery was the most expensive modality, OVHR was also significantly costlier than LVHR, which was the least expensive. Long-term data on recurrence could not be evaluated and should be studied to determine the role of robotic surgery in VHR and recurrence rates.",
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AU - Oleynikov, Dmitry

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