Procedural Costs of Robot-Assisted and Laparoscopic Ventral and Incisional Hernia Repair. A Propensity-Score Matched Nationwide Database Study

Background: The utilization of the robotic platform for ventral hernia repair is increasing, however is facing criticism for perceived high costs. This study aimed to compare the procedure-specific costs of robot-assisted ventral or incisional hernia repair with laparoscopic repair. Methods: This propensity score-matched nationwide database study included patients undergoing primary ventral and incisional hernia repair from 2017 to 2022. A total of 554 patients undergoing robot-assisted repair were matched 1:1 with patients undergoing laparoscopic repair by the confounding variables of age, type of hernia (primary ventral/incisional), and horizontal defect size. The primary outcome was the total cost per procedure in Euros including robotic/laparoscopic approach, mesh, tackers, length of stay, readmission, and operative reintervention. The price of obtaining laparoscopic and robotic systems was not included. Results: The length of stay was significantly shorter, and readmission rate was significantly lower for robot-assisted repairs (0.5 days and 7.0%) than for laparoscopic repairs (1.2 days and 12.5%), P < 0.001 and P = 0.003, respectively. The mean procedural cost of an incisional hernia repair was significantly reduced with the robot-assisted approach (1,533 Euros (sd: 1,584)) compared to the laparoscopic approach (2,077 Euros (sd: 1,840), P = 0.002). Multivariable linear regression analysis confirmed that robotic ventral hernia repair was independently associated with decreased overall costs (coeff −682.1, CI −1,331.5 - −32.6, P = 0.040). Conclusion: For primary ventral hernias, the mean procedural costs of a robot-assisted and a laparoscopic repair are comparable, but for incisional hernia repairs the mean procedural cost is decreased with a robot-assisted approach.