Massachusetts Chapter of the American College of Surgeons

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A Comparison of Clinical Outcomes and Costs Between Robotic and Open Ventral Hernia Repair- A 9-year Experience
Georges Kaoukabani, MD, MSc1,2, Naseem Bou-Ayash, MD2, Alexander Friedman, MD2, Kelly Vallar, MD, FACS1, Fahri Gokcal, MD1,2, Omar Yusef Kudsi, MD, MBA, FACS1,2
1Good Samaritan Medical Center, Brockton, MA, USA; 2Tufts Medical Center, Boston, MA, USA

Background: With robotic ventral hernia repair increasing, evidence is needed to ensure appropriate utilization. Being cognizant of and minimizing health-care costs should be a priority. Goal of this study is to compare clinical outcomes and total costs of robotic and open ventral hernia repair.
Methods: A retrospective analysis was performed to compare clinical outcomes, and perioperative and downstream costs, of robotic and open ventral hernia repairs. Average follow-up time was 28 months.
Results: 808 open and 683 robotic ventral hernia repairs were included. After inverse probability treatment weighting, patientsí demographics and hernia characteristics were comparable between both groups. Hospital length of stay did not differ in either approach. Clavien-Dindo complications grade-IIIa and IIIb were significantly lower in the robotic arm (1.4% vs 4.7%, 4.1% vs 11.3%, respectively, p>0.001). Robotic repairs resulted in less surgical site infections and occurrences in comparison to open repairs (3.8% vs 8.9%, 9% vs. 12.7%, p<0.001, p=0.025, respectively). Higher recurrence rates were seen in the open group (10.7% vs. 2.9%, p<0.001). Hospital costs were significantly higher for robotic repairs by $3048, whereas post-discharge costs were significantly higher in open repairs by $1259. Overall, total costs were significantly higher by $1789 in the robotic group.
Conclusion: This study provides a comprehensive analysis of clinical outcomes and costs in the largest series of ventral hernia repairs. While both open and robotic ventral hernia repairs offer encouraging clinical outcomes, the robotic group had lower complications and recurrence rates, at a higher cost to the open approach.


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