Akademik Veri Yönetim Sistemi
SAGES , Montreal, Kanada, 29 Mart - 01 Nisan 2023, cilt.37, ss.347, (Tam Metin Bildiri)
Objective: To compare outcomes and costs between laparoscopic and
robotic inguinal hernia repairs (LIHR, RIHR)
Methods: Elective LIHR or RIHR from 2012 to 2022 were reviewed.
Patients’ demographics, operative details, postoperative outcomes,
and financial burden (hospital, post-discharge, total costs) were
compared using univariate statistical tests. Multiple linear regression
analysis was performed to determine associations between preoperative
variables and increased costs.
Results: 588 LIHR and 644 RIHR were included. Patient demographics
did not differ except for the American Society of
Anesthesiologists (ASA). Bilateral hernias rate was comparable
(p = 0.132; RIHR: 34.2% vs. LIHR:28.9%). Rate of complex hernia
(inguinal hernias previously repaired with posterior approach, history
of open prostatectomy, incarcerated hernias, scrotal hernias) was
higher in RIHR (p\0.001; 29% vs. LIHR: 12%). Median operating
time was * 20 min longer in RIHR (p\0.001). Intraoperative
complications rates were comparable (p = 0.99). Rates of peritoneal
breach during preperitoneal dissection and of conversion were higher
in LIHR than in RIHR. Length of hospital stay did not differ
(p = 0.097). Clavien–Dindo Grade IIIB complication rate and mean
Comprehensive Complication Index were higher in LIHR than RIHR
(3.4% vs. 1.4% and 2.6 vs. 1.7, respectively, p = 0.024). Sixteen (
3%) patients experienced a hernia recurrence in LIHR versus 4 (0.7%)
in RIHR (p = 0.003). Mean hospital cost was significantly $896
(p\0.001) higher in RIHR. Mean post-discharge cost was $155
(p = 0.03) lower in RIHR. Mean (95%-Confidence Interval) total cost
was significantly higher (p\0.001) in RIHR [5869(5607–6130) vs.
5128(4875–5381)]. The robotic approach, higher ASA scores, prior
posterior IHR, previous prostatectomy, and bilateral inguinal hernia
were independently associated with each cost component (table).
Conclusion: RIHR provided lower recurrence and complication rates
in more complex hernias at a higher total cost. Hernia complexity,
ASA class, choice of approach, and