Utilization of Laparoscopic and Open Inguinal Hernia Repair: A Population-Based Analysis

Abstract

Laparoscopic inguinal hernia repair is a safe, effective treatment for inguinal hernias and is considered, by some, to be the procedure of choice for recurrent inguinal hernias. Little is known, however, about the frequency with which laparoscopic inguinal hernia repair is performed and the determinants of its utilization. We performed a retrospective cohort study of all patients undergoing outpatient inguinal hernia repairs in Florida in 2002 and 2003, using the AHRQ State Ambulatory Surgery Database. We compared patient demographics, indication for procedure, location of procedure (i.e., hospital or ambulatory surgery center), and charges for laparoscopic and open repairs. Of 58,172 outpatient inguinal hernia repairs, 11,351 (19.5%) were performed laparoscopically. In the subset of 6221 recurrent inguinal hernias, only 1276 (20.5%) were performed laparoscopically. Patients undergoing a laparoscopic repair were younger (52.7 versus 57.4 years; P < 0.001), more likely to be of the white race (84.4 vs. 79.3%; P < 0.001), and more likely to have private insurance (62.0 versus 47.2%; P < 0.001), compared to those undergoing open repair. Laparoscopic repairs resulted in higher charges than open repairs ($12,087 versus $7,580; P < 0.001). Laparoscopic repairs were less commonly performed at ambulatory surgery centers (ASCs) than at hospitals (13.7 versus 20.9%; P < 0.001), although ASCs had significantly lower charges for laparoscopic hernia repairs than did hospitals ($6,973 versus $12,860; P < 0.001). The laparoscopic approach is used in only a small fraction of initial and recurrent inguinal hernia repairs and is used more commonly at hospitals than at ASCs. Although clinical indications play a role, the use of laparoscopy for inguinal hernia repair may also be influenced by financial considerations.