Michimasa Fujiogi1, Nobuaki Michihata2, Hiroki Matsui3, Kiyohide Fushimi4, Hideo Yasunaga3, Jun Fujishiro5. 1. Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo. 2. Department of Health Services Research, Graduate School of Medicine, The University of Tokyo. 3. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo. 4. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School. 5. Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo. Electronic address: jfujishi-tky@umin.ac.jp.
Abstract
BACKGROUND: This study compared perioperative outcomes between laparoscopic surgery (LS) and open surgery (OS) for pediatric inguinal hernia repair, using a national inpatient database. METHODS: Using the Diagnosis Procedure Combination database in Japan, we compared duration of anesthesia, postoperative complications, recurrence, and metachronous hernia (MH) between LS and OS for children undergoing inguinal hernia repair from July 2010 to March 2016. We used multivariable logistic regression analysis for postoperative complications and Cox regression analysis for recurrence. RESULTS: For 75,486 eligible patients (LS 20,186 vs. OS 55,300), the median follow-up was 815 (381-1350) days in LS and 1106 (576-1603) days in OS. The duration of anesthesia was significantly longer in LS than in OS for unilateral surgery (80 vs. 70min, p<0.001) but shorter for bilateral surgery (86 vs. 96min, p<0.001). LS had a lower proportion of MH than OS (0.3% vs. 3.4%, p<0.001). There was no significant difference between LS and OS in complications (odds ratio: 0.55; 95% confidence interval: 0.22-1.38; p=0.20) or recurrence (hazard ratio: 1.24; 95% confidence interval: 0.86-1.79; p=0.89). CONCLUSIONS: LS patients had lower proportions of MH than OS patients. Complications and recurrence did not differ significantly between LS and OS. TYPE OF STUDY: Retrospective study. LEVELS OF EVIDENCE: Level III.
BACKGROUND: This study compared perioperative outcomes between laparoscopic surgery (LS) and open surgery (OS) for pediatric inguinal hernia repair, using a national inpatient database. METHODS: Using the Diagnosis Procedure Combination database in Japan, we compared duration of anesthesia, postoperative complications, recurrence, and metachronous hernia (MH) between LS and OS for children undergoing inguinal hernia repair from July 2010 to March 2016. We used multivariable logistic regression analysis for postoperative complications and Cox regression analysis for recurrence. RESULTS: For 75,486 eligible patients (LS 20,186 vs. OS 55,300), the median follow-up was 815 (381-1350) days in LS and 1106 (576-1603) days in OS. The duration of anesthesia was significantly longer in LS than in OS for unilateral surgery (80 vs. 70min, p<0.001) but shorter for bilateral surgery (86 vs. 96min, p<0.001). LS had a lower proportion of MH than OS (0.3% vs. 3.4%, p<0.001). There was no significant difference between LS and OS in complications (odds ratio: 0.55; 95% confidence interval: 0.22-1.38; p=0.20) or recurrence (hazard ratio: 1.24; 95% confidence interval: 0.86-1.79; p=0.89). CONCLUSIONS: LS patients had lower proportions of MH than OSpatients. Complications and recurrence did not differ significantly between LS and OS. TYPE OF STUDY: Retrospective study. LEVELS OF EVIDENCE: Level III.