학술논문
Clinical outcomes and costs of retromuscular and intraperitoneal onlay mesh techniques in robotic incisional hernia repair.
Document Type
Article
Source
Subject
*PERITONEUM surgery
*SURGICAL robots
*PEARSON correlation (Statistics)
*BODY mass index
*DATA analysis
*POSTOPERATIVE pain
*COST analysis
*FISHER exact test
*TREATMENT effectiveness
*DESCRIPTIVE statistics
*CHI-squared test
*MANN Whitney U Test
*SURGICAL complications
*ELECTRONIC health records
*STATISTICS
*COMPARATIVE studies
*SURGICAL site infections
*DATA analysis software
*SURGICAL meshes
*HOSPITAL costs
*EVALUATION
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Language
ISSN
1866-6817
Abstract
Background: This study aims to compare clinical outcomes and financial cost of intraperitoneal onlay mesh (IPOM) versus retromuscular (RM) repairs in robotic incisional hernia repairs (rIHR). Methods: Patients who underwent either IPOM or RM elective rIHR from 2012 to 2022 were included. Demographics, operative details, postoperative outcomes, and hospital costs were directly compared. Results: Sixty-nine IPOM and 55 RM were included. Age and body mass index (BMI) did not differ between both groups (IPOM vs RM: 59.3 ± 11.2 years vs. 57.5 ± 14 years, p = 0.423; BMI 34.1 ± 6.3 vs. BMI 33.2 ± 6.9, p = 0.435, respectively). Comorbidities and hernia characteristics were comparable. Extensive lysis of adhesions (> 30 min) was required more often in IPOM (18 vs. 6 in RM, p = 0.034). Defect closure was achieved in 100% of RM vs. 81.2% in IPOM (p < 0.001). Median (interquartile range) postoperative pain score was higher in RM than in IPOM [5(3–7) vs. 4(3–5), respectively, p = 0.006]. Median length of stay (0 day) and same-day discharge rate did not differ between groups (p = 0.598, p = 0.669, respectively). Six (8.7%) patients in the IPOM group versus one (1.8%) patient in the RM group were readmitted to hospital within 30 days postoperatively (p = 0.099). Perioperative complications were higher in IPOM (p = 0.011; 34.8% vs. 14.5% in RM) with higher Comprehensive Complication Index® morbidity scores [0(0–12.2) vs 0(0–0) in RM, p = 0.008)], Clavien–Dindo grade-II complications (8 vs 0 in RM, p = 0.009), and surgical site events (17 vs. 5 in RM, p = 0.024). Within a follow-up period of 57(± 28) months, recurrence rates were similar between both groups. Hospital costs did not differ between groups [IPOM: $9978 (7031–12,926) vs. RM: $8961(6701–11,222), p = 0.300]. Although postoperative complication costs were higher in IPOM ($2436 vs RM: $161, p = 0.020), total costs were comparable [IPOM: $12,415(8700–16,130) vs. RM: $9123(6789–11,457), p = 0.080]. Conclusion: Despite retromuscular repairs having lower postoperative complications than intraperitoneal onlay mesh repairs, both techniques offered encouraging results in robotic incisional hernia repair at a comparable total cost. [ABSTRACT FROM AUTHOR]