Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 1/2013

01-01-2013

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

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

Published in: Surgical Endoscopy | Issue 1/2013

Login to get access

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.
Literature
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):179–183CrossRefPubMed
2.
LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41PubMed
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
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 21:378–386CrossRefPubMed
5.
Lomanto D, Iyer SG, Shabbir A, Cheah WK (2006) Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc 20:1030–1035CrossRefPubMed
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 21:555–559CrossRefPubMed
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 17:1778–1780CrossRefPubMed
8.
Beldi G, Ipaktchi R, Wagner M, Gloor B, Candinas D (2006) Laparoscopic ventral hernia repair is safe and cost effective. Surg Endosc 20:92–95CrossRefPubMed
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 20:71–75CrossRefPubMed
10.
Goodney PP, Birkmeyer CM, Birkmeyer JD (2002) Short-term outcomes of laparoscopic and open ventral hernia repair: a meta-analysis. Arch Surg 137:1161–1165CrossRefPubMed
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 142:562–567CrossRefPubMed
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 35:297–301CrossRefPubMed
13.
Heniford BT, Park A, Ramshaw BJ, Voeller G (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190:645–650CrossRefPubMed
14.
Kirshtein B, Lantsberg L, Avinoach E, Bayme M, Mizrahi S (2002) Laparoscopic repair of large incisional hernias. Surg Endosc 16:1717–1719CrossRefPubMed
15.
LeBlanc KA, Whitaker JM (2002) Management of chronic postoperative pain following incisional hernia repair with Composix mesh: a report of two cases. Hernia 6:194–197CrossRefPubMed
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
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 17:123–128CrossRefPubMed
18.
Pring CM, Tran V, O’Rourke N, Martin IJ (2008) Laparoscopic versus open ventral hernia repair: a randomized controlled trial. ANZ J Surg 78:903–906CrossRefPubMed
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 23:1441–1448CrossRefPubMed
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)CrossRefPubMed
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 11:51–56CrossRefPubMed
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 20:1839–1845CrossRefPubMed
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 17:86–90CrossRefPubMed
24.
25.
Hegamin AP (2001) International classification of diseases, 9th rev. Clinical modification, 6th edn. Medicode Publications, Salt Lake City
26.
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 40:373–383CrossRefPubMed
28.
Quan H, Parsons GA, Ghali WA (2002) Validity of information on comorbidity derived rom ICD-9-CCM administrative data. Med Care 40:675–685CrossRefPubMed
29.
Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619CrossRefPubMed
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 43:1130–1139CrossRefPubMed
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)CrossRefPubMed
32.
D’Hoore W, Sicotte C, Tilquin C (1993) Risk adjustment in outcome assessment: the Charlson comorbidity index. Methods Inf Med 32:382–387PubMed
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 49:1429–1433CrossRefPubMed
34.
35.
Wang YR, Dempsey DT, Richter JE (2011) Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993–2006. Dis Esophagus 24:215–223CrossRefPubMed
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 206:638–644CrossRefPubMed
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 36:8–27CrossRefPubMed
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 53:666–672CrossRefPubMed
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 39:727–739CrossRefPubMed
41.
Southern DA, Quan H, Ghali WA (2004) Comparison of the Elixhauser and Charlson/Deyo methods of comorbidity measurement in administrative data. Med Care 42:355–360CrossRefPubMed
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 11:146CrossRefPubMed
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 47:626–633CrossRefPubMed
Metadata
Title
Laparoscopic versus open hernia repair: outcomes and sociodemographic utilization results from the nationwide inpatient sample
Authors
Paul D. Colavita
Victor B. Tsirline
Amanda L. Walters
Amy E. Lincourt
Igor Belyansky
B. Todd Heniford
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 1/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-012-2432-z

Other articles of this Issue 1/2013

Surgical Endoscopy 1/2013 Go to the issue

Review

Laparoscopic versus open colorectal resection in the elderly population

OriginalPaper

Factors affecting the treatment of multiple colorectal adenomas

Erratum

Erratum to: Surgeons don’t know what they don’t know about the safe use of energy in surgery

OriginalPaper

Effects of age and cholecystectomy on common bile duct diameter as measured by endoscopic ultrasonography

OriginalPaper

Transrectal peritoneal access with the submucosal tunnel technique in NOTES: a porcine survival study

OriginalPaper

Minimally invasive surgical approach for the treatment of gastroparesis