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Nationwide Readmissions Analysis of Minimally Invasive Versus Open Ventral Hernia Repair: A Retrospective
Sullivan A Ayuso1, Michael M Katzen1, Bola G Aladegbami2
1Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA.
Introduction:
Minimally invasive ventral hernia repair (MISVHR) has been performed for almost 30 years; recently, there has been an accelerated adoption of the robotic platform leading to renewed comparisons to open ventral hernia repair (OVHR). The present study evaluates patterns and outcomes of readmissions for MISVHR and OVHR patients.
Methods:
The Nationwide Readmissions Database (NRD) was queried for patients undergoing OVHR and MISVHR from 2016 to 2018. Demographic characteristics, complications, and 90-day readmissions were determined. A subgroup analysis was performed to compare robotic ventral hernia repair (RVHR) vs laparoscopic hernia repair (LVHR). Standard statistical methods and logistic regression were used.
Results:
Over the 3-year period, there were 25 795 MISVHR and 180 635 OVHR admissions. Minimally invasive ventral hernia repair was associated with a lower rate of 90-day readmission (11.3% vs 17.3%, P < .01), length of stay (LOS) (4.0 vs 7.9 days, P < .01), and hospital charges ($68,240 ± 75 680 vs $87,701 ± 73 165, P < .01), which remained true when elective and non-elective repairs were evaluated independently. Postoperative infection was the most common reason for readmission but was less common in the MISVHR group (8.4% vs 16.8%, P < .01). Robotic ventral hernia repair increased over the 3-year period and was associated with decreased LOS (3.7 vs 4.1 days, P < .01) and comparable readmissions (11.3% vs 11.2%, P = .74) to LVHR, but was nearly $20,000 more expensive. In logistic regression, OVHR, non-elective operation, urban-teaching hospital, increased LOS, comorbidities, and payer type were predictive of readmission.
Conclusions:
Open ventral hernia repair was associated with increased LOS and increased readmissions compared to MISVHR. Robotic ventral hernia repair had comparable readmissions and decreased LOS to LVHR, but it was more expensive.
Insights
Minimally invasive ventral hernia repair (MISVHR) shows lower readmission rates and shorter hospital stays compared to open ventral hernia repair (OVHR). Robotic ventral hernia repair (RVHR) offers similar readmission rates to laparoscopic repair but at a higher cost.
Area of Science:
- Abdominal Surgery
- Surgical Outcomes
- Health Services Research
Background:
- Minimally invasive ventral hernia repair (MISVHR) adoption is increasing, prompting comparisons with open ventral hernia repair (OVHR).
- Robotic platforms are accelerating MISVHR use, necessitating updated outcome analyses.
- Understanding readmission patterns is crucial for evaluating different hernia repair techniques.
Purpose of the Study:
- To compare 90-day readmission rates and outcomes between MISVHR and OVHR.
- To analyze trends and outcomes of robotic ventral hernia repair (RVHR) versus laparoscopic ventral hernia repair (LVHR).
- To identify predictors of readmission after ventral hernia repair.
Main Methods:
- Analysis of the Nationwide Readmissions Database (NRD) from 2016-2018.
- Comparison of demographic characteristics, complications, and 90-day readmissions for OVHR and MISVHR.
- Subgroup analysis of RVHR versus LVHR, utilizing logistic regression.
Main Results:
- MISVHR had significantly lower 90-day readmission rates (11.3% vs 17.3%) and shorter length of stay (LOS) than OVHR.
- Postoperative infection was the most common readmission reason, but less frequent in MISVHR.
- RVHR showed decreased LOS compared to LVHR, with comparable readmission rates but higher costs.
Conclusions:
- OVHR is associated with higher LOS and readmission rates compared to MISVHR.
- RVHR demonstrates reduced LOS and similar readmissions to LVHR, though at an increased expense.
- Factors like OVHR, non-elective surgery, and comorbidities predict higher readmission risk.
