Time-efficiency and hospital costs of open compared with laparoscopic groin hernia repair in a teaching hospital

BACKGROUND: Time efficiency and hospital costs may influence the preferred method of groin hernia repair. Despite growing expertise in laparoscopic hernia repair, knowledge on the actual costs and the potential financial advantages over open hernia repair are limited.METHODS: A single-center retrospective cohort study comparing hospital costs and time-efficiency of open-mesh (Lichtenstein) and laparoscopic groin hernia repair between 2010 and 2015, including a comparison of surgeons and residents, was conducted. Secondary outcomes were length of hospital stay, complication and recurrence rates.RESULTS: Nine hundred forty-seven open and 449 laparoscopic groin hernia repairs were included. Unilateral open repair showed a shorter operation theatre occupancy (63.5 min +/- 17.2 vs. 71.9 min +/- 19.9, P<0.001) and lower total costs ((sic) 974.51 +/- 266.67 vs. (sic) 1165.32 +/- 285.94, P<0.001) compared with laparoscopic repair. Residents had longer operative times compared with surgeons in the unilateral open procedure (43.8 +/- 13.4 min vs. 34.5 +/- 16.3 min, P<0.001), in the unilateral laparoscopic procedure (46.9 +/- 16.6 min vs. 41.7 +/- 18.7 min, P<0.001) and higher total costs in the unilateral open procedure ((sic) 1007.47 +/- 238.58 vs. (sic) 909.35 +/- 305.00, P<0.001). There were no significant differences in complication and recurrence rates between residents and surgeons.CONCLUSIONS: Open-mesh hernia repair appears to be superior in costs for both uni- and bilateral groin hernias when performed by surgeons as well as residents. Residents had higher total costs and longer operation times in the unilateral open groin hernia group when compared with surgeons, yet overall complications and recurrence rates were similar in all groups suggesting that residents are sometimes more expensive and slower, but just as safe.