Table 3. Sensitivity Analyses With Hazard Ratios (HRs) for Operative Recurrence at 1, 3, 5, 7, and 10 Years After Robotic-Assisted, Laparoscopic, and Open Ventral Hernia Repair From 2010-2020.
| Variable | Years after repair, HR (95% CI) | ||||
|---|---|---|---|---|---|
| 1 | 3 | 5 | 7 | 10 | |
| Obesity | |||||
| Patients with obesity | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 0.84 (0.74-0.94) | 0.77 (0.67-0.87) | 0.74 (0.63-0.85) | 0.72 (0.60-0.84) | 0.70 (0.57-0.83) |
| Open | 0.92 (0.82-1.02) | 0.85 (0.75-0.95) | 0.82 (0.70-0.93) | 0.79 (0.67-0.92) | 0.77 (0.64-0.91) |
| Patients without obesity | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 0.95 (0.87-1.03) | 0.87 (0.77-0.96) | 0.83 (0.72-0.94) | 0.81 (0.69-0.93) | 0.79 (0.65-0.93) |
| Open | 0.95 (0.90-1.05) | 0.90 (0.80-0.99) | 0.86 (0.75-0.98) | 0.84 (0.72-0.97) | 0.82 (0.68-0.96) |
| No. of comorbidities | |||||
| 0-1 | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 0.95 (0.85-1.07) | 0.88 (0.77-0.99) | 0.84 (0.72-0.96) | 0.82 (0.68-0.95) | 0.79 (0.65-0.94) |
| Open | 0.97 (0.82-1.14) | 0.93 (0.83-1.04) | 0.90 (0.77-1.02) | 0.87 (0.74-1.01) | 0.85 (0.70-1.00) |
| ≥2 | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 0.91 (0.83-0.98) | 0.83 (0.74-0.91) | 0.79 (0.69-0.90) | 0.77 (0.66-0.89) | 0.75 (0.62-0.88) |
| Open | 0.94 (0.87-1.00) | 0.86 (0.77-0.94) | 0.82 (0.72-0.93) | 0.80 (0.68-0.92) | 0.78 (0.65-0.91) |
| Myofascial flapa | |||||
| Flap use | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 2.74 (1.88-3.6) | 2.43 (1.65-3.20) | 2.30 (1.53-3.06) | 2.21 (1.45-2.98) | 2.13 (1.36-2.90) |
| Open | 0.49 (0.36-0.63) | 0.43 (0.31-0.55) | 0.40 (0.28-0.52) | 0.39 (0.27-0.51) | 0.37 (0.25-0.49) |
| No flap use | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 0.74 (0.66-0.81) | 0.65 (0.57-0.73) | 0.62 (0.52-0.71) | 0.59 (0.49-0.70) | 0.57 (0.45-0.69) |
| Open | 0.89 (0.80-0.97) | 0.77 (0.68-0.86) | 0.72 (0.61-0.84) | 0.69 (0.57-0.82) | 0.66 (0.52-0.80) |
| ICD version | |||||
| ICD-9 (2010-September 2015)b | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 0.90 (0.79-1.01) | 0.83 (0.72-0.93) | 0.80 (0.68-0.91) | NA | NA |
| Open | 0.98 (0.86-1.12) | 0.90 (0.79-1.02) | 0.87 (0.74-0.99) | NA | NA |
| ICD-10 (October 2015-2020)b | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 0.99 (0.88-1.11) | 0.93 (0.80-1.05) | 0.89 (0.75-1.03) | NA | NA |
| Open | 0.89 (0.82-0.96) | 0.81 (0.72-0.90) | 0.78 (0.67-0.88) | NA | NA |
| Individual surgeon robotic-assisted ventral hernia repair volume (percentile rank) | |||||
| 0%-25% | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 0.98 (0.74-1.24) | 0.91 (0.69-1.13) | 0.88 (0.66-1.09) | 0.85 (0.64-1.07) | 0.83 (0.62-1.05) |
| Open | 0.99 (0.85-1.15) | 0.97 (0.76-1.19) | 0.94 (0.73-1.15) | 0.91 (0.70-1.13) | 0.89 (0.67-1.10) |
| 26%-75% | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 0.87 (0.71-1.03) | 0.80 (0.64-0.95) | 0.77 (0.61-0.93) | 0.75 (0.59-0.91) | 0.73 (0.56-0.89) |
| Open | 0.98 (0.88-1.12) | 0.92 (0.77-1.07) | 0.88 (0.72-1.05) | 0.86 (0.69-1.03) | 0.84 (0.66-1.01) |
| 76%-100% | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 0.84 (0.73-0.96) | 0.78 (0.66-0.89) | 0.75 (0.63-0.87) | 0.73 (0.60-0.85) | 0.71 (0.58-0.84) |
| Open | 0.99 (0.84-1.14) | 0.92 (0.79-1.05) | 0.88 (0.74-1.02) | 0.86 (0.71-1.01) | 0.84 (0.68-0.99) |
| Individual surgeon robotic-assisted ventral hernia repair proportion of all ventral hernia repairs | |||||
| 0%-25% | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 0.87 (0.65-1.09) | 0.79 (0.60-0.99) | 0.76 (0.57-0.96) | 0.74 (0.55-0.93) | 0.72 (0.52-0.91) |
| Open | 0.99 (0.78-1.20) | 0.90 (0.70-1.11) | 0.87 (0.66-1.07) | 0.84 (0.63-1.05) | 0.82 (0.60-1.03) |
| 26%-75% | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 0.86 (0.73-0.99) | 0.79 (0.66-0.91) | 0.75 (0.63-0.88) | 0.73 (0.60-0.86) | 0.71 (0.57-0.85) |
| Open | 0.97 (0.85-1.10) | 0.89 (0.76-1.01) | 0.85 (0.72-0.99) | 0.83 (0.68-0.97) | 0.80 (0.65-0.96) |
| 76%-100% | |||||
| Robotic-assisted | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Laparoscopic | 0.93 (0.77-1.09) | 0.85 (0.70-1.00) | 0.81 (0.66-0.97) | 0.79 (0.64-0.95) | 0.77 (0.61-0.93) |
| Open | 1.09 (0.93-1.24) | 1.00 (0.84-1.15) | 0.95 (0.79-1.12) | 0.93 (0.76-1.10) | 0.90 (0.72-1.08) |
Abbreviations: ICD-9, International Classification of Diseases, Ninth Revision; ICD-10, International Classification of Diseases, Tenth Edition; NA, not applicable.
a
Myofascial flap analysis was performed using ventral or incisional subtype hernias only, as the technique is most commonly used for large or complex hernias and the number of umbilical hernias with myofascial flap composed less than 1% of all hernias coded with myofascial flap use.
b
Only 5 years of data were available for ICD-9 and ICD-10 sensitivity analyses.