Comparative Analysis of Recurrence and Healthcare Expenditures After Primary Inguinal Hernia Repair Using Robotic-Assisted, Laparoscopic, and Open Surgical Approaches

OBJECTIVES: Over 800,000 inguinal hernia repairs (IHR) are performed every year in the United States. Minimally invasive operations are recommended for female, bilateral, and recurrent cases, but no one standard repair technique for primary unilateral IHR. Limited literature compares recurrence and healthcare expenditures after primary unilateral IHR between surgical approaches, hence we sought to compare robotic-assisted (RAS), laparoscopic (Lap) and Open approaches.

METHODS: A retrospective cohort study of outpatient primary unilateral IHR performed between 2015 and 2020 was conducted using the MarketScan® Research Databases. Outcomes include recurrence rates at 1- and 2-year, and healthcare expenditure through 1-year post-dishcharge. Inverse-probability of treatment weighting adjusted analyses were performed.

RESULTS: A total of 58,110 eligible patients were identified (2,463 [4.2%] RAS, 23,781 [40.9%] Lap, and 31,866 [54.5%] Open). Patients who had RAS had similar 1-year and 2-year recurrence as compared to Lap or Open (both p > 0.05). Compared to Open, RAS was associated with lower 1-year post-discharge expenditure (adjusted mean difference [AMD] = -$1,823, 95% CI = -$2,789 to -$858, p < 0.001), offsetting the higher index expenditure at cumulative (p = 0.190). However, laparoscopic IHR had higher recurrence at 1-year (OR= 1.30, 95% CI = 1.06 to 1.59, p = 0.010) and 2-year (HR = 1.20, 95% CI = 1.02 to 1.40, p = 0.027) than Open. Lap IHR had higher index expenditure (AMD = $2,468, 95% CI = $2,376 to $2,559, p < 0.001), and in cumulative at 1-year (AMD = $2,033, 95% CI = $1,516 to $2,549, p < 0.001) as compared to Open.

CONCLUSIONS: In this cohort analysis of commercially-insured patients, Lap IHR had a higher recurrence rate than Open, whereas RAS and Open had similar rates. Compared to Open, lower post-discharge expenditures after RAS resulted in offsetting higher index expenditure, but Lap and Open IHR had similar post-discharge expenditures.