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Objective:
Use of laparoscopic ventral hernia repair (LVHR) has been increasing. We evaluated the outcomes of LVHR compared with open ventral hernia repair (OVHR) in obese patients.
Design:
Retrospective Cohort Analysis
Setting and Patients:
Obese patients from 2008 to 2009 were selected from the Nationwide Inpatient Sample database.
Interventions:
LVHR and OVHR were selected using the ICD-9 codes.
Main Outcome Measures:
Data analysis included intraoperative and postoperative complications, length of stay (LOS), and total hospital charges (THC). Additional demographics including insurance, median income and locations were analyzed.
Results:
A total of 47,675 obese patients underwent ventral hernia repair during the study period. LVHR increased more than four-fold, 1,552 (6.5%) to 6,671 (28.1%), P<0.001. LVHR was associated with a lower overall complication rate (6.3% vs 13.7%, P<0.001), shorter median LOS (3 days vs 4 days, P<0.001), and lower mean THC ($40,387 vs $48,513, P<0.001). Multivariate regression analysis identified predictive variable for LVHR: Private insurance (OR 1.204, CI 1.146-1.265, P<0.001) and highest median income quartile (OR 1.257, CI 1.181-1.339, P<0.001). Ventral hernia with gangrenous bowel was less likely to undergo LVHR, (OR 0.142, CI 0.059-0.341, P<0.001). Metropolitan location and ventral hernia with bowel obstruction were not statistically significant predictors.
Conclusions:
In the era of laparoscopy, the utilization of LVHR in obese patients has increased significantly. LVHR appears to be safe with lower cost of care, however gangrenous bowel may preclude safe LVHR. Variations in insurance status and income may reflect existing healthcare disparity in access to specialty care in the United States.