title: Laparoscopic versus open elective repair of primary umbilical hernias: short-term outcomes from the American College of Surgeons National Surgery Quality Improvement Program.
abstract: BACKGROUND
  Approximately 175,000 umbilical hernia repairs are performed annually in the US. Controversy exists regarding the optimal approach for the elective repair of primary umbilical hernias.
  
  
  OBJECTIVE
  The objective of this study was to compare 30-day outcomes of elective primary open (OHR) and laparoscopic (LHR) umbilical hernia repairs, using a prospectively collected dataset.
  
  
  METHODS
  We performed a retrospective cohort study using the American College of Surgeons National Surgery Quality Improvement Program Participant Use Files during 2009 and 2010. Current Procedural Terminology and post-operative International Classification of Diseases, Ninth Revision diagnostic codes were used to identify primary umbilical hernia repairs. Primary outcomes included composite endpoints of 30-day mortality, and major and overall complications. Univariate analyses and multivariate logistic regression were performed controlling for relevant patient characteristics. Secondary outcomes included operative time and hospital length of stay (LOS).
  
  
  RESULTS
  Overall, 14,652 patients were identified-13,109 (89.5 %) OHR and 1543 (10.5 %) LHR. Univariate analyses of primary outcomes demonstrated similar 30-day morbidity and mortality between groups. In our multivariate model, however, after controlling for body mass index, gender, American Society of Anesthesiologists class, and chronic obstructive pulmonary disease, the odds ratio (OR) for overall complications favored LHR (OR 0.60; p = 0.01). This difference was driven primarily by the reduced wound complication rate in the LHR group [OR 0.41 (0.20, 0.78); p = 0.005]. LHR was associated with significantly longer operative time [57.7 min (SD 32.6) vs. 38.3 min (SD 22.9); p < 0.001], longer LOS [0.29 days (SD 0.68) vs. 0.17 days (SD 1.47); p = 0.001], and an increased rate of respiratory (0.52 vs. 0.10 %; p < 0.001) and cardiac (0.26 vs. 0.05 %; p = 0.005) complications.
  
  
  CONCLUSIONS
  This study identified potential decreased total and wound morbidity associated with LHR for elective primary umbilical hernia repairs at the expense of increased operative time, LOS, and respiratory and cardiac complications. These results should be considered within the context of a retrospective study with its inherent risks of bias and limitations.
authors.affiliation: Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada, sgcassie@gmail.com.
authors.forename: Scott
authors.initials: S
authors.lastname: Cassie
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.forename: Fady
authors.initials: F
authors.lastname: Saleh
authors.forename: Fayez S
authors.initials: FS
authors.lastname: Quereshy
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
mesh_terms: D017558:Elective Surgical Procedures / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006554:Hernia, Umbilical / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods* / Q000592:standards; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000592:standards*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology