- •A retrospective review of open and robotic ventral hernia repairs (OVHR, RVHR).
- •Clinical outcomes and detailed costs of 675 OVHRs and 609 RVHRs were compared.
- •The robotic group had lower postoperative adverse events.
- •Hospital costs were higher for RVHR, but post-discharge expenses favored RVHR.
- •RVHR could generate comparable total costs to OVHR.
As robotic ventral hernia repair(VHR) adoption increases, real-world evidence is needed to ensure appropriate utilization.
Data for open and robotic VHR(OVHR, RVHR) was retrospectively analyzed. Outcomes and costs were compared via inverse probability treatment weighting using propensity scores to estimate the average treatment effect on the treated for RVHR.
675 open and 609 robotic ventral hernia repairs were included. Demographics and hernia characteristics were comparable. Complications rates were lower in RVHR(p < 0.001). Clavien-Dindo grade-III complications were lower in RVHR(13.2% vs. 4.9%, p < 0.001). RVHR resulted in fewer surgical site events(21.5% vs. 12.2%, p < 0.001). Recurrence rates were greater in OVHR(8.9% vs. 2.8%, p < 0.001). The higher RVHR hospital costs (Δ = $2456, p = 0.005) were balanced by the lower post-discharge costs, compared to OVHR(Δ = $799, p = 0.023). Total costs did not differ(Δ = $1656 p = 0.081).
Although hospital costs were higher, post-discharge expenses favored RVHR due to the lower postoperative complications, which lead to comparable total costs to OVHR.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The American Journal of Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Trends in the adoption of robotic surgery for common surgical procedures.JAMA Netw Open. 2020 Jan 3; 3 (PubMed PMID: 31922557. Pubmed Central PMCID: PMC6991252. Epub 20200103. eng)e1918911
- Clinical outcomes and cost of robotic ventral hernia repair: systematic review.BJS Open. 2021 Nov 9; (PubMed PMID: 34791049. Pubmed Central PMCID: PMC8599882. eng): 5
- Robotic vs Open Approach for Older Adults Undergoing Retromuscular Ventral Hernia Repair. Ann Surg.2021 Oct 22 (PubMed PMID: 35129505. Epub 20211022. eng)
- Classification of primary and incisional abdominal wall hernias.Hernia. 2009 Aug; 13 (PubMed PMID: 19495920. Pubmed Central PMCID: PMC2719726. Epub 20090603): 407-414
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004 Aug; 240 (PubMed PMID: 15273542. Pubmed Central PMCID: PMC1360123): 205-213
- The comprehensive complication index: a novel continuous scale to measure surgical morbidity.Ann Surg. 2013 Jul; 258 (PubMed PMID: 23728278): 1-7
- Comparison of cost center–specific vs hospital-wide cost-to-charge ratios for operating room services at various hospital types.JAMA Surg. 2019; 154: 557-558
- (US Inflation Calculator. ; Available from:)
- Toolkit for Weighting and Analysis of Nonequivalent Groups: A Tutorial for the R TWANG Package.RAND Corporation, Santa Monica, CA2022
- Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies.Stat Med. 2015 Dec 10; 34 (PubMed PMID: 26238958. Pubmed Central PMCID: PMC4626409. Epub 20150803. eng): 3661-3679
- Propensity weighting: how to minimise comparative bias in non-randomised studies?.Eur J Cardiovasc Nurs. 2020 Jan; 19 (PubMed PMID: 31856606): 83-88
- Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Short-term outcomes from a systematic review with meta-analysis.Hernia. 2021 Dec; 25 (PubMed PMID: 34491460. Pubmed Central PMCID: PMC8613152. Epub 20210907): 1471-1480
- Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair.Surg Endosc. 2018 Feb; 32 (PubMed PMID: 28730275. Epub 20170720): 727-734
- Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release.Surg Endosc. 2018 Feb; 32 (PubMed PMID: 28733746. Epub 20170721): 840-845
- Reducing length of stay using a robotic-assisted approach for retromuscular ventral hernia repair: a comparative analysis from the americas hernia society quality collaborative.Ann Surg. 2018 Feb; 267 (PubMed PMID: 28350568. eng): 210-217
- The perfect plane: a systematic review of mesh location and outcomes, update 2018.Plast Reconstr Surg. 2018 Sep; 142 (16S. PubMed PMID: 30138278): 107S
- Defects and donuts: the importance of the mesh:defect area ratio.Hernia. 2016 Dec; 20 (PubMed PMID: 27585805. Epub 20160901): 893-895
- Robotic ventral hernia repair: lessons learned from a 7-year experience.Ann Surg. 2022 Jan 1; 275 (PubMed PMID: 34380969. eng): 9-16
- Epidemiology and cost of ventral hernia repair: making the case for hernia research.Hernia. 2012 Apr; 16 (PubMed PMID: 21904861. Epub 20110909. eng): 179-183
- Preventing recurrence in clean and contaminated hernias using biologic versus synthetic mesh in ventral hernia repair: the PRICE randomized clinical trial.Ann Surg. 2021 Apr 1; 273 (PubMed PMID: 33443907. eng): 648-655
- Robotic ventral hernia repair: a safe and durable approach.Hernia. 2021 Apr; 25 (PubMed PMID: 31776878. Epub 20191127. eng): 305-312
- Robotic surgery costs: revealing the real villains.Int J Med Robot. 2021 Dec; 17 (PubMed PMID: 34268880. Epub 20210821. eng)e2311
- Robotic ventral hernia repair is not superior to laparoscopic: a national database review.Surg Endosc. 2018 Apr; 32 (PubMed PMID: 29052065. Epub 20171019. eng): 1834-1839
- Validation and extension of the ventral hernia repair cost prediction model.J Surg Res. 2019 Dec; 244 (PubMed PMID: 31288184. Epub 20190706. eng): 153-159
Published online: February 01, 2023
Accepted: January 31, 2023
Received in revised form: January 11, 2023
Received: November 30, 2022
Publication stageIn Press Journal Pre-Proof
© 2023 Elsevier Inc. All rights reserved.