title: The utilization of laparoscopy in ventral hernia repair: an update of outcomes analysis using ACS-NSQIP data.
abstract: BACKGROUND
  Numerous prospective studies and randomized controlled trials have demonstrated shorter length of stay, lower morbidity rates, and similar recurrence rates with laparoscopic ventral hernia repair (VHR) when compared to open VHR. Despite these promising results, previous data showed low utilization of laparoscopic VHR. The aim of our study was to evaluate the utilization of laparoscopic VHR using the most updated information from the American College of Surgeons-National Surgical Quality Improvement Project (NSQIP) dataset. The secondary aim was to evaluate the outcomes from NSQIP for patients undergoing open versus laparoscopic VHR for the outcome of 30-day mortality and the peri-operative morbidities listed in the NSQIP dataset.
  
  
  METHODS
  We performed this study using 2009-2012 data from the ACS-NSQIP database. The study population included patients who had undergone an open or laparoscopic ventral hernia repair as their primary procedure based on CPT codes. Demographic characteristics, overall morbidity, and complications were compared using Chi-square tests for categorical variables and two-sided t tests for continuous variables. Secondary outcomes (mortality and any complications) were further analyzed using logistic regression.
  
  
  RESULTS
  Utilization of laparoscopic VHR was 22%. While adjusted mortality was similar, overall morbidity was increased in the open VHR group (OR 1.63; CI 95% 1.38-1.92). The open group had a higher rate of return to the OR, pneumonia, re-intubation, ventilator requirement, renal failure/insufficiency, transfusion, DVT, sepsis, and superficial and deep incisional wound infections.
  
  
  CONCLUSIONS
  The utilization of laparoscopic VHR remained low from 2009 to 2012 and continued to lag behind the use of laparoscopy in other complex surgical procedures. The mortality rate between laparoscopic and open VHR was similar, but laparoscopic repair was associated with lower overall complication rates.
authors.affiliation: Department of General Surgery, Professional Building, Suite 810, Rush University Medical Center, 1725 West Harrison Street, Chicago, IL, 60612, USA, chetan_aher@rush.edu.
authors.forename: Chetan V
authors.initials: CV
authors.lastname: Aher
authors.forename: John C
authors.initials: JC
authors.lastname: Kubasiak
authors.forename: Shaun C
authors.initials: SC
authors.lastname: Daly
authors.forename: Imke
authors.initials: I
authors.lastname: Janssen
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Deziel
authors.forename: Keith W
authors.initials: KW
authors.lastname: Millikan
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Myers
authors.forename: Minh B
authors.initials: MB
authors.lastname: Luu
mesh_terms: D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D058996:Quality Improvement; D012008:Recurrence; D014945:Wound Healing