A. Salous1, K. Sweeney1, J. Coleman1, C. D’Adamo2, V. Ahuja1 1SInai Hospital of Baltimore,Surgery,Baltimore, MD, USA 2University Of Maryland,Baltimore, MD, USA
Introduction: Hernia repair is one of the most commonly performed operations in general surgery. The last two decades witnessed increased utilization of the laparoscopic approach for repair of ventral and inguinal hernias. However, the trends in these approaches continue to emerge and are still presently unclear. The purpose of this study is to examine the patient characteristics and outcomes of open versus laparoscopic hernia repair.
Methods: A retrospective review of all inguinal and ventral hernia were identified using CPT codes as the principle operation from 2007 to 2017 using ACS NSQIP database. This database can identify outpatient and inpatient surgery with 30 days follow up. The primary outcome was the patient characteristics by type of repair. The secondary outcome was complications with statistical significance calculated using chi square in the difference by laparoscopic vs open by patient characteristics, type of surgery and preoperative variables.
Results: A total of 504,824 met the criteria with 338,319 open and 166,505 laparoscopic. By operation type, open was preferred for both inguinal 69.6% and ventral hernia 64.5% (p <0.01). Open was the most utilized in other race (73.5%), blacks (68.6%), then white (63.5%) (p<0.01) and the patients were older (open 58.1 years vs. laparoscopic 55.4 years). Open approach had higher complications 5.6% compared to laparoscopic 2.5% with wound infection 2.7% vs. 0.7% (p<0.001). The trend in outcomes by open vs. laparoscopic was seen by patient hospital setting with inpatient 15.5% vs. 7.5% and outpatient 2.0% vs. 1.5% respectively. Complications were higher in black patients in both inguinal and ventral hernia repair regardless of the approach. Open repair had higher complication rates compared to laparoscopic (white 6.3% vs 2.6%, black 7.0% vs 3.1%, other 4.5% vs 2.4% respectively) (p=0.02).
Conclusion: The study findings show that inguinal and ventral hernia repair operations benefit from a laparoscopic approach. There is a race disparity with open repair being more common in black and other race patients while laparoscopic approach is seen in white patients. The trend in complications by race highlight the choice of open vs laparoscopic repair.
