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Objectives: Open inguinal hernia repair has been the mainstay in both elective and emergent hernias for most of surgical history. The advancement of laparoscopic hernia repair has challenged this notion; however few trials have compared the laparoscopic approach to open. We sought to query the NSQIP database to amass a large number of patients to better characterize patent comorbidities and outcomes of both approaches.
Methods: The NSQIP database was queried for laparoscopic or open inguinal hernia repair for unilateral hernias from 2007 to 2009. Age, gender and comorbidities were quantified and outcomes data collected. Specifically, morbidity, mortality, length of stay and operative times were examined. Statistical analysis was then performed. A p-value of < 0.05 was considered significant.
Results: A total of 29,755 patients were identified, out of which 25,192 underwent open hernia repair, while 4,563 underwent laparoscopic repair.
Conclusions: Our study revealed that only 15% of unilateral hernias were repaired laparoscopically. The more diverse anesthetic choices available for open repair allowed patients with significant comorbidities to undergo hernia repair. Despite this there was an increased overall rate of morbidity (0.5% vs. 0.2%, p = 0.012). Other outcomes measures were not different except for length of stay, which was longer for the open group.
Conclusions: Our study revealed that only 15% of unilateral hernias were repaired laparoscopically. The more diverse anesthetic choices available for open repair allowed patients with significant comorbidities to undergo hernia repair. Despite this there was an increased overall rate of morbidity (0.5% vs. 0.2%, p = 0.012). Other outcomes measures were not different except for length of stay, which was longer for the open group.
Table 1. Patient Comorbdities

	Open Repair N=25192	Laproscopic Repair N=4563	P-Value
Age	55.9 ± 17.3	52.3 ± 16.1	<.001
Male gender	22668 (90%)	4155 (91.1%)	0.026
Diabetes on oral	1190 (4.7%)	143 (3.1%)	<.001
Diabetes on Insulin	383 (1.5%)	36 (0.8%)	<.001
HTN	8987 (35.7%)	1314 (28.8%)	<.001
COPD	727 (2.9%)	59 (1.3%)	<.001
CHF in 30 days	41 (0.2%)	4(0.1%)	0.301
History of MI in 6months	35 (0.1%)	1 (0.0%)	0.035
Prior PCI	1334 (5.3%)	167 (3.7%)	<.001
Prior CABG	1414 (5.6%)	168 (3.7%)	<.001
PAD	189 (0.8%)	189 (0.8%)	.005
ESRD	133 (0.5%)	13 (0.3%)	0.033
BMI	26.3 ± 4.3	26.5 ± 4.3	0.006
Anesthesia type General Local MAC Spinal	16776 (66.6%) 534 (2.1%) 6414 (25.5%) 979 (3.9%)	4473 (98.0%) 5 (0.1%) 73 (1.6%) 8 (0.2%)	<0.001
ASA III or above	378 (1.5%)	23 (0.1%)	<.001
Bleeding disorder	567 (2.3%)	63 (1.4%)	<.001
Partially Dependent	200 (0.8%)	16 (0.4%)	0.001
Steroid use	345 (1.4%)	36 (0.8%)	.001
Smoker	5054 (20.1%)	772 (16.9%)	<.001

Table 2. Postoperative outcome and complications.

	Open Repair N=25192	Laparoscopic Repair N=4563	P-Value
Superficial SSI	87 (0.3%)	13 (0.3%)	0.572
Deep incisional SSI	18 (0.1%)	2 (0.0%)	0.757
Organ space SSI	11 (0.0%)	0	0.392
Wound disruption	10 (0.0%)	1 (0.0%)	1
Pneumonia	27 (0.1%)	1 (0.0%)	0.112
Unplanned Intubation	16 (0.1%)	1 (0.0%)	0.498
PE	14 (0.1%)	2 (0%)	1
Failure to extubate	7 (0.0%)	1 (0%)	1
Return to OR	177 (0.7%)	24 (0.5%)	0.204
ARF	5 (0%)	0	1
Cardiac arrest	59 (0.2%)	0	0.600
MI	14 (0.1%)	2 (0%)	1.0
DVT	19 (0.1%)	1 (0.0%)	0.246
Sepsis	26 (0.1%)	2 (0%)	0.3
Neuro complication	16 (0.1%)	2 (0%)	1
Overall morbidity	141 (0.5%)	12 (0%)	.012
Operative time (mins	58.6 ± 26.9	59.2 ± 31.3	0.183
Hospital stay (days)	0.27 ± 3.9	0.16 ± 1.2	<0.001
Mortality	18 (0.1%)	1 (0%)	0.342