BACKGROUND Robotics offers improved ergonomics, visualization, instrument articulation, and tremor filtration. Disadvantages include startup cost and system breakdown. Surgeon education notwithstanding, we hypothesize that robotic inguinal hernia repair carries minimal advantages over the laparoscopic or open approach. METHODS The 2009-2015 Healthcare Cost and Utilization Project-State Ambulatory Surgery and Services and American Hospital Association Annual Health datasets from FL were queried for Open, Laparoscopic and Robotic inguinal hernia repairs. Hospital and patient demographic, financial and comorbidity data (26 total variables) were evaluated. Data are presented as mean+SEM; p < 0.05 was considered significant. RESULTS 103183 cases (63375 Open, 38886 Laparoscopic, and 922 Robotic were identified. Patient characteristics were: male, white, age 51-70, non-govt and non-profit hospital, grouped Charlson Comorbidity Category (CC)=0, private insurance coverage, median income quartile 3 (4=highest), and routine discharge disposition. (All p<0.05) Total charges were: $18261+38 (Open), $25223+60 (Lap) and $45830+1023 (Robot). (p<0.0001 Robot vs Open, Robot vs Lap and Lap vs Open) Top factors associated with: Open (AUC 0.785)= Hospital-investor owned for profit, self-pay, Black, Latino, and Medicaid; Lap (AUC 0.771)= private insurance, median income quartile 4 (highest), median income quartile 3, median income quartile 2, and Hospital-non govt, not for profit; and Robotic (AUC 0.936)= CC=2, CC=1, median income quartile 3, median income quartile 2, and age. CONCLUSION Robotic surgery has increased charges and is performed in sicker, higher income patients. The open approach is more apt to be performed in Black/Hispanic, self-pay patients and for-profit hospitals. The role for robotic inguinal hernia repair is undefined.
Haroon Janjua, Evelena Cousin-Peterson, Tara M Barry
Journal of the American College of Surgeons