title: Comparison of hospital costs and length of stay associated with open-mesh, totally extraperitoneal inguinal hernia repair, and transabdominal preperitoneal inguinal hernia repair: an analysis of observational data using propensity score matching.
abstract: BACKGROUND
  Laparoscopic inguinal hernia surgery is increasingly seen as the superior technique in hernia repair. Compared to open-mesh hernia repair, laparoscopic approaches are often reported to be more cost-effective but incur higher costs for the provider. The objective of this study was to analyze the effect of transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repair of nonincarcerated inguinal hernias in men on hospital costs and length of stay (LoS).
  
  
  METHODS
  We used routine administrative, highly standardized, patient-level cost data from 15 German hospitals participating in the national cost data study. We compared TEP, TAPP, and open-mesh repair. We conducted propensity score matching to account for baseline differences between treatment groups and subsequently estimated the treatment effect on costs and LoS.
  
  
  RESULTS
  Total costs for both TEP and TAPP surgery were significantly lower than those for open-mesh repair (p < 0.0001 and p < 0.05, respectively). TEP repair also had a slight but nonsignificant advantage in total costs compared to TAPP repair, while TAPP surgery was associated with a significantly shorter LoS than TEP (p < 0.001).
  
  
  CONCLUSIONS
  Results suggest that laparoscopic approaches in hernia repair are not necessarily associated with higher hospital resource consumption than open-mesh repair.
authors.affiliation: Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Sekretariat H80, Strasse des 17. Juni 135, 10623, Berlin, Germany. friedrich.wittenbecher@charite.de
authors.forename: Friedrich
authors.initials: F
authors.lastname: Wittenbecher
authors.forename: David
authors.initials: D
authors.lastname: Scheller-Kreinsen
authors.forename: Julia
authors.initials: J
authors.lastname: Röttger
authors.forename: Reinhard
authors.initials: R
authors.lastname: Busse
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006552:Hernia, Inguinal / Q000191:economics* / Q000601:surgery*; D059685:Herniorrhaphy / Q000191:economics* / Q000379:methods*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum; D057216:Propensity Score; D013526:Surgical Mesh / Q000191:economics*; D055815:Young Adult