In-hospital outcomes of robotic versus laparoscopic inguinal hernia repair in obese patients: a national inpatient sample analysis 2005–2020

摘要

PURPOSE: Obesity is associated with complications in surgical procedures and postoperative outcomes. This study aims to compare in-hospital outcomes of robotic inguinal hernia repair (RIHR) and laparoscopic inguinal hernia repair (LIHR) in obese patients. METHODS: Data from the National Inpatient Sample (NIS) from 2005 to 2020 were used in this study. Inclusion criteria were ≥ 18 years old with obesity (body mass index ≥ 30 kg/m²) who underwent either RIHR or LIHR. Data were analyzed for in-hospital mortality, length of stay (LOS), total hospital costs, and complications. RESULTS: A total of 647 patients were included. Multivariable analysis showed RIHR was associated with a significantly lower risk of any complications (adjusted odds ratio [aOR] = 0.53, 95% confidence interval [CI]: 0.36, 0.77), shorter LOS (adjusted Beta [aBeta] = -0.94, 95%CI: -1.02, -0.86), and higher total hospital costs (aBeta = 5.62, 95%CI: 4.80, 6.44). Stratified analysis revealed that the lower risk of complications with RIHR was consistent across most subgroups, including age < 60 years (aOR = 0.56) and ≥ 60 years (aOR = 0.53), non-smokers (aOR = 0.53) and smokers (aOR = 0.48), non-hypertensive (aOR = 0.27) and hypertensive patients (aOR = 0.66), and non-diabetic (aOR = 0.53) and diabetic patients (aOR = 0.44), as well as patients admitted during 2017-2020 (aOR = 0.50). CONCLUSIONS: RIHR is associated with lower complication risk and shorter LOS, but higher hospital costs compared to LIHR for obese patients. These findings suggest that RIHR may offer better short-term outcomes for obese patients, which should be considered in surgical decision-making. Given the retrospective nature of this analysis and the potential for selection bias and residual confounding, future randomized controlled trials are warranted to confirm these findings and provide more robust evidence to guide surgical decision-making.