Same-day discharge after robotic hernia repair tied to age, wound infection, operative time, and mesh area

USA: A recent article published in the Journal of Laparoendoscopic and Advanced Surgical Techniques has specified four-factor on which Same-Day Discharge depends after Robotic Transversus Abdominis Release for Incisional Hernia Repair depends. These are the patient's age, wound infection history, length of the operative time, and mesh area.

Robotic-assisted techniques for ventral hernia repair are rapidly adopted due to the procedure's minimally invasive nature. This technique has made those interventions possible, which are otherwise difficult to manage.

There are three goals in hernia treatment. They are the restoration of abdominal wall function, abdominal cavity expansion, and tension reduction. Meshes are used to reduce tension in the repair. The concomitant usage of mesh and the separation of abdominal wall components poses numerous advantages and allows for achieving the goal.

The separation components are tied to complications like ischemia, dehiscence, infection and seroma formation, etc. This could be combated by minimally invasive surgeries like Robotic Transversus Abdominis Release. This procedure leads to lower postoperative morbidity rates and shorter hospital stays.

A study by Charles et al. has concluded that robotic repair has a higher skin and soft tissue infection rate associated with a greater length of operative time. The procedure has a higher cost, due to which patient preference plays a significant role in the decision and choice for robotic surgery. The same study has mentioned that 510 patients who were operated on for unilateral inguinal hernia repair by robotic, laparoscopic, or open repair had different Operative duration (Robot: 105 vs. Lap: 81 vs. Open: 71 min, p < 0.001) and were discharged home the same day as they had no operative mortalities except one patient.

The data on this background remains limited, and more conclusive studies are required to give detailed data. Considering this, a study was conducted by Dr. Omar Yusef Kudsi from the Department of Surgery at Good Samaritan Medical Center and Tufts University School of Medicine to evaluate "What are the factors that influence SDD after robotic transversus abdominis release (rTAR)?"

The conclusive points of the study are:

• There were two groups: the SDD group and the inpatient group.

• The length of stay in the SDD group was <1, while in the inpatient group, it was ≥1 day.

• Patients with a history of rTAR for incisional hernias were assigned to either the SDD or the inpatient group.

• The comparison was made for Pre-, intra-, and postoperative variables.

• Logistic regression was used to Predict SDD.

• Mediation analysis was performed to assess the effect on the LOS.

• One hundred sixty-seven patients were included in the study.

• On the same day, a total of 53 patients were discharged.

• The values significantly higher in the inpatient group were age, American Society of Anesthesiologists score, positive history of coronary artery disease, and history of wound infection.

• Overall, the length of median LOS was 1 (0–2).

• There was no difference in postoperative complications between SDD and inpatient groups; the exception was Clavien–Dindo Grade-II,1 versus 14, respectively. The P value was 0.039.

• Thirty-day readmission rates were comparable with a P value of 0.229.

• The factors predicted for SDD in rTAR were age, length of the operative time, mesh area, and the history of wound infection. There were significant and were determined by binary logistic regression.

• The mesh size indirectly affected the Length of Stay (through operative time) depicted by median analysis, and the p-value was P < .001.

The conclusion by researchers was, "Age >46-year, an operative time of more than 217 minutes, and a mesh size >475 cm2 are the important considerations that increase the probability of an inpatient stay." They wrote.

Further investigations are warranted to investigate how appropriate the discharge decisions are while balancing the benefits of the patient, utilization of the resources, and the costs, as robotic surgeries are costly.

Further reading:

Omar Yusef Kudsi, Georges Kaoukabani, Naseem Bou-Ayash, Kelly Vallar, and Fahri Gokcal.Analysis of Factors Associated with Same-Day Discharge After Robotic Transversus Abdominis Release for Incisional Hernia Repairs.Journal of Laparoendoscopic & Advanced Surgical Techniques. ahead of print http://doi.org/10.1089/lap.2022.0426