title: Laparoscopic versus open ventral hernia repair: longitudinal outcomes and cost analysis using statewide claims data.
abstract: BACKGROUND
  There is still considerable debate regarding the best operative approach to ventral hernia repair. Using two large statewide databases, this study sought to evaluate the longitudinal outcomes and associated costs of laparoscopic and open ventral hernia repair.
  
  
  METHODS
  All patients undergoing elective ventral hernia repair from 2007-2011 were identified from inpatient discharge data from California and New York. In-hospital morbidity, in-hospital mortality, incidence of readmission, and incidence of revisional ventral hernia repair were evaluated as a function of surgical technique. The associated costs of medical care for laparoscopic versus open ventral hernia repair were evaluate for both the index procedure and all subsequent admissions and procedures within the study period.
  
  
  RESULTS
  A total of 13,567 patients underwent elective ventral hernia repair with mesh; 9228 (69%) underwent OVHR and 4339 (31%) underwent LVHR. At time of the index procedure, LVHR was associated with a lower incidence of reoperation (OR 0.29, CI 0.12-0.58, p = 0.001), wound disruption (OR 0.35, CI 0.16-0.78, p = 0.01), wound infection (OR 0.50, CI 0.25-0.70, p < 0.001), blood transfusion (OR 0.47, CI 0.36-0.61, p < 0.001), ARDS (OR 0.74, CI 0.54-0.99, p < 0.05), and total index visit complications (OR 0.72, CI 0.64-0.80, p < 0.001). LVHR was associated with significantly fewer readmissions (OR 0.81, CI 0.75-0.88, p < 0.001) and a lower risk for revisional VHR (OR 0.75, CI 0.64-0.88, p < 0.001). LVHR was associated with lower total costs at 1 year ($3451, CI 1892-5011, p < 0.001).
  
  
  CONCLUSIONS
  Open ventral hernia repair was associated with a higher incidence of perioperative complications, postoperative readmissions and need for revisional hernia repair when compared to laparoscopic ventral hernia repair, even when controlling for patient sociodemographics. In congruence, open ventral hernia repair was associated with higher costs for both the index hernia repair and tallied over the length of follow-up for readmissions and revisional hernia repair.
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA. Brett.Ecker@uphs.upenn.edu.
authors.forename: Brett L
authors.initials: BL
authors.lastname: Ecker
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Lindsay E Y
authors.initials: LE
authors.lastname: Kuo
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Kristina D
authors.initials: KD
authors.lastname: Simmons
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jon B
authors.initials: JB
authors.lastname: Morris
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
mesh_terms: D002140:California / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000191:economics* / Q000379:methods / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010351:Patient Discharge; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies
keywords: Complication; Incisional hernia repair; Laparoscopic ventral hernia repair; Laparoscopic versus open; Open ventral hernia repair; Ventral hernia