• Haroon Janjua, Evelena Cousin-Peterson, Tara M Barry, Marissa C Kuo, Marshall S Baker, and Paul C Kuo.
• Department of Surgery, University of South Florida, Tampa, FL; OnetoMap Analytics, University of South Florida, Tampa, FL.
• J. Am. Coll. Surg. 2020 Jul 1; 231 (1): 61-72.

BackgroundRobotics offers improved ergonomics, visualization, instrument articulation, and tremor filtration. Disadvantages include startup cost and system breakdown. Surgeon education notwithstanding, we hypothesize that robotic inguinal hernia repair carries minimal advantages over the laparoscopic or open approach.MethodsThe 2009-2015 Healthcare Cost and Utilization Project-State Ambulatory Surgery and Services and American Hospital Association Annual Health data sets from Florida were queried for open, laparoscopic, and robotic inguinal hernia repairs. Hospital and patient demographic, financial, and comorbidity data (26 total variables) were evaluated. Data are presented as mean ± SEM; p < 0.05 was considered significant.ResultsWe identified 103,183 cases (63,375 open, 38,886 laparoscopic, and 922 robotic). Patient characteristics were the following: male, white, aged 51 to 70 years, nongovernmental and not-for-profit hospitals, grouped Charlson Comorbidity Category = 0, private insurance coverage, median income quartile 3 (4 = highest), and routine discharge disposition (all, p < 0.05). Total charges were: $18,261 ± $38 (open), $25,223 ± $60 (laparoscopic), and $45,830 ± $1,023 (robot) (p < 0.0001 robot vs open, robot vs laparoscopic, and laparoscopic vs open). Top factors associated with open procedures (area under the curve 0.785): hospital is investor owned for profit, self-pay, black, Latino, and Medicaid; with laparoscopic procedures (area under the curve 0.771): private insurance, median income quartile 4 (highest), median income quartile 3, median income quartile 2, and nongovernmental, not-for-profit hospitals; and with robotic procedures (area under the curve 0.936): Charlson Comorbidity Category = 2, Charlson Comorbidity Category = 1, median income quartile 3, median income quartile 2, and age.ConclusionsRobotic surgery has increased charges and is performed in sicker, higher-income patients. The open approach is more apt to be performed in black/Hispanic, self-pay patients, and for-profit hospitals. The role for robotic inguinal hernia repair is undefined.Copyright © 2020 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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