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P026: A COST ANALYSIS OF TWO VERSUS THREE INSTRUMENT ROBOTIC-ASSISTED INGUINAL HERNIA REPAIR WITH MESH: TIME IS MONEY
Omar Bellorin, MD1; Mariana Vigiola-Cruz, MD1; Rachel Alt, MD2; Gregory Dakin, MD1; Cheguevara Afaneh, MD1; 1NYP/ Weill Cornell Medical College; 2Valley Hospital
BACKGROUND: Adoption of robotic-assisted inguinal hernia repair (RIHR) has been on the rise with favorable outcomes. Cost remains a significant concern with the use of the robotic platform. We compare the cost-effectiveness of two- vs three-instrument robotic-assisted inguinal hernia repair by two expert robotic surgeons.
METHODS: Using a prospectively collected database, we retrospectively reviewed all patients undergoing RIHR by two surgeons using the robotic-assisted transabdominal preperitoneal approach between January 2015 and December 2019. Inclusion criteria were unilateral primary inguinal hernias and adult patients. Exclusion criteria included recurrent inguinal hernias, bilateral repairs, and/or concomitant procedures performed. Both surgical techniques were identical and the same mesh material and size were used. Each surgeon had expertise using either a two-instrument technique (2IT) or a three-instrument technique (3IT). 2IT RIHR were performed with a large needle driver-suture cut and fenestrated bipolar grasper, while the 3IT RIHR were performed using a large needle driver, monopolar shears, and fenestrated bipolar grasper. Primary outcomes were operative time and morbidity. Secondary outcomes were length of stay, readmission rate, and recurrence rate at 90 days. A cost analysis was also performed. Recurrence rates were documented radiographically or by physical exam. Categorical variables were analyzed using the Chi-square or Fisher exact test as appropriate. Continuous variables were analyzed using Mann-Whitney U-test. A cost-analysis was performed based on operating room costs per minute.
RESULTS: A total of 172 patients were included; 86 patients in each group. After 1:1 matching, there were no significant differences in gender, age, body mass index (BMI), ASA score, prior abdominal surgery, and proportion of active smokers between the two groups (P>0.05). There was no significant difference in primary or secondary outcomes between the two groups (P>0.05). The mean(±SD) operative times was 6 minutes longer in the 2IT group (68±17.4 vs 62±9.3; P=0.02). The cost difference between the 2IT group and 3IT group is $300. The use of two instruments is cost-effective for operating room costs of less than $50 per minute. Operating room costs greater than $50 per minute favors the use of three instruments. The use of 2IT for operating room costs of $60/minutes, $70/minute, and $80/minute increased costs by $60, $120, and $180, respectively.
CONCLUSION: Both the two- and three-instrument RIHR can be performed with equal efficacy in our study. The cost saving of using two or three instruments for RIHR depends on the surgeon’s efficiency and the operating room cost per minute.
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