title: Reducing Length of Stay Using a Robotic-assisted Approach for Retromuscular Ventral Hernia Repair: A Comparative Analysis From the Americas Hernia Society Quality Collaborative.
abstract: The aim of this study was to compare length of stay (LOS) after robotic-assisted and open retromuscular ventral hernia repair (RVHR).
  
  
  
  RVHR has traditionally been performed by open techniques. Robotic-assisted surgery enables surgeons to perform minimally invasive RVHR, but with unknown benefit. Using real-world evidence, this study compared LOS after open (o-RVHR) and robotic-assisted (r-RVHR) approach.
  
  
  
  Multi-institutional data from patients undergoing elective RVHR in the Americas Hernia Society Quality Collaborative between 2013 and 2016 were analyzed. Propensity score matching was used to compare median LOS between o-RVHR and r-RVHR groups. This work was supported by an unrestricted grant from Intuitive Surgical, and all clinical authors have declared direct or indirect relationships with Intuitive Surgical.
  
  
  
  In all, 333 patients met inclusion criteria for a 2:1 match performed on 111 r-RVHR patients using propensity scores, with 222 o-RVHR patients having similar characteristics as the robotic-assisted group. Median LOS [interquartile range (IQR)] was significantly decreased for r-RVHR patients [2 days (IQR 2)] compared with o-RVHR patients [3 days (IQR 3), P < 0.001]. No differences in 30-day readmissions or surgical site infections were observed. Higher surgical site occurrences were noted with r-RVHR, consisting mostly of seromas not requiring intervention.
  
  
  
  Using real-world evidence, a robotic-assisted approach to RVHR offers the clinical benefit of reduced postoperative LOS. Ongoing monitoring of this technique should be employed through continuous quality improvement to determine the long-term effect on hernia recurrence, complications, patient satisfaction, and overall cost.
authors.affiliation: Department of Surgery, Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine, Greenville, SC.
authors.forename: Alfredo M
authors.initials: AM
authors.lastname: Carbonell
authors.affiliation: Department of Surgery, Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine, Greenville, SC.
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Warren
authors.affiliation: Department of General Surgery, Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Main Campus, Cleveland, OH.
authors.forename: Ajita S
authors.initials: AS
authors.lastname: Prabhu
authors.affiliation: Department of General Surgery, Center for Minimally Invasive and Robotic Surgery, Abrazo Arrowhead Hospital, Glendale, AZ.
authors.forename: Conrad D
authors.initials: CD
authors.lastname: Ballecer
authors.affiliation: Department of Surgery, Oakland University/William Beaumont School of Medicine, William Beaumont Hospital, Royal Oak, MI.
authors.forename: Randy J
authors.initials: RJ
authors.lastname: Janczyk
authors.affiliation: Department of General Surgery, North Florida Surgeons, St. Vincent's Medical Center, Jacksonville, FL.
authors.forename: Javier
authors.initials: J
authors.lastname: Herrera
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, 571 Preston Building, Nashville, TN.
authors.forename: Li-Ching
authors.initials: LC
authors.lastname: Huang
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, 571 Preston Building, Nashville, TN.
authors.forename: Sharon
authors.initials: S
authors.lastname: Phillips
authors.affiliation: Department of General Surgery, Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Main Campus, Cleveland, OH.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
authors.affiliation: Department of Surgery, Division of General Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Poulose
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*