Department of Surgery, General Surgery, University of Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, NE, USA.
Surg Endosc. 2020 Feb;34(2):821-828. doi: 10.1007/s00464-019-06835-6. Epub 2019 May 28.
This study compares the impact of open (OIHR) versus laparoscopic (LIHR) inguinal hernia repair on healthcare spending and postoperative outcomes.
The TRUVEN database was queried using ICD9 procedure codes for open, laparoscopic, and robotic-assisted IHR, from 2012 to 2013. Patients > 18 years of age and continuously enrolled for 12 months postoperatively were included. Demographics, patient comorbidities, postoperative complications, pain medication use, length of hospital stay, missed work hours, postoperative visits, and overall expenditure were collected, and assessed at time of surgery and at 30-, 60-, 90-, 180-, and 365-days postoperatively. Statistical analysis was conducted using SAS, with α = 0.05.
66,116 patients were included (LIHR: N = 23,010; OIHR: N = 43,106). Robotic-assisted procedures were excluded due to small sample size (N = 61). The largest demographic was males between 55 and 64 years. LIHR had fewer surgical wound complications than OIHR (LIHR: 0.3%; OIHR: 0.5%, p = 0.007), less utilization of pain medication (LIHR: 23.3%; OIHR: 28.5%; p < 0.001), and fewer outpatient visits. In the 90-day postoperative period, LIHR had significantly fewer missed work hours (LIHR: 12.1 ± 23.2 h; OIHR: 12.9 ± 26.7 h, p = 0.023). LIHR had higher postoperative urinary complications (LIHR: 0.2%; OIHR: 0.1%; p < 0.001), consistent with the current literature. LIHR expenditures ($15,030 ± $25,906) were higher than OIHR ($13,303 ± 32,014), p < 0.001.
The results highlight the benefits of laparoscopic repair with regard to surgical wound complications, postoperative pain, outpatient visits, and missed work hours. These improved outcomes with respect to overall healthcare spending and employee absenteeism support the paradigm shift toward laparoscopic inguinal hernia repairs, in spite of higher overall expenditures.
本研究比较了开放式（OIHR）与腹腔镜（LIHR）腹股沟疝修补术对医疗保健支出和术后结果的影响。
使用 TRUVEN 数据库，通过 ICD9 手术代码查询 2012 年至 2013 年的开放式、腹腔镜和机器人辅助 IHR。纳入年龄大于 18 岁且术后连续 12 个月入组的患者。收集患者的人口统计学资料、患者合并症、术后并发症、止痛药物使用、住院时间、误工时间、术后就诊次数和总支出，并在手术时和术后 30、60、90、180 和 365 天进行评估。使用 SAS 进行统计学分析，α=0.05。
共纳入 66116 例患者（LIHR：N=23010；OIHR：N=43106）。由于样本量小（N=61），机器人辅助手术被排除在外。最大的人群是 55 至 64 岁的男性。LIHR 的手术切口并发症少于 OIHR（LIHR：0.3%；OIHR：0.5%，p=0.007），止痛药物使用率较低（LIHR：23.3%；OIHR：28.5%，p<0.001），门诊就诊次数较少。在术后 90 天，LIHR 的误工时间明显减少（LIHR：12.1±23.2 h；OIHR：12.9±26.7 h，p=0.023）。LIHR 的术后尿潴留并发症较高（LIHR：0.2%；OIHR：0.1%，p<0.001），与当前文献一致。LIHR 的支出（$15030±$25906）高于 OIHR（$13303±$32014），p<0.001。
结果突出了腹腔镜修复在手术切口并发症、术后疼痛、门诊就诊次数和误工时间方面的优势。这些改善的结果与整体医疗保健支出和员工缺勤率有关，支持了向腹腔镜腹股沟疝修补术的范式转变，尽管整体支出较高。
