BACKGROUND This study compares the impact of open (OIHR) versus laparoscopic (LIHR) inguinal hernia repair on healthcare spending and postoperative outcomes. METHODS 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. RESULTS 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. CONCLUSIONS 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.

中文翻译：

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腹腔镜腹股沟疝修补术与开放性腹股沟疝修补术的结果及其对医疗保健支出和员工缺​​勤的影响。

背景本研究比较开放式（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。方法使用开放式，腹腔镜式和机器人辅助IHR的ICD9程序代码（从2012年至2013年）查询TRUVEN数据库。研究对象包括18岁以上且术后连续入组12个月的患者。收集人口统计资料，患者合并症，术后并发症，止痛药的使用时间，住院时间，错过的工作时间，术后就诊以及总支出，并在手术时以及30、60、90、180，术后365天。使用SAS进行统计分析，α= 0.05。结果纳入66,116例患者（LIHR：N = 23,010； OIHR：N = 43,106）。由于样本量小（N = 61），因此排除了机器人辅助程序。人口最多的是55至64岁之间的男性。LIHR的手术伤口并发症比OIHR少（LIHR：0.3％; OIHR：0.5％，p = 0.007），止痛药的利用率较低（LIHR：23.3％; OIHR：28.5％; p <0.001），门诊就诊次数更少。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具有较高的术后泌尿并发症（LIHR：0.2％； OIHR：0.1％； p <0.001），与当前文献一致。LIHR支出（$ 15,030±$ 25,906）高于OIHR（$ 13,303±32,014），p <0.001。结论该结果凸显了腹腔镜修复在手术伤口并发症，术后疼痛，门诊就诊，和错过的工作时间。尽管总体支出增加，但总体医疗支出和员工缺​​勤方面的这些改善的结果支持了向腹腔镜腹股沟疝修补术的转变。