State-Level Examination of Clinical Outcomes and Cost for Robotic and Laparoscopic Approach to Diaphragmatic Hernia Repair

Background Published studies evaluating the effect of robotic-assistance on clinical outcomes and costs of care in diaphragmatic hernia repair (DHR) have been limited. Study Design The Healthcare Cost and Utilization Project State Inpatient and State Ambulatory Surgery and Services Databases for Florida were queried to identify patients undergoing transabdominal DHR between 2011 and 2018 and associated inpatient and outpatient encounters within 12 months following the index operation. Patients undergoing robotic DHR were 1:1:1 propensity score matched for age, sex, race, Elixhauser comorbidity score, case priority, payer, and facility volume to patients undergoing open and laparoscopic DHR. Results 5,962 (67.3%) patients underwent laparoscopic DHR, 1,520 (17.2%) open DHR, and 1,376 (15.5%) robotic DHR. On comparison of matched cohorts, median index length of stay (LOS) (3 days IQR [2, 5] vs. 2 days IQR [1, 4], p Conclusion Laparoscopic DHR is the most cost-effective approach to DHR. Robotic-assistance provides clinical outcomes comparable to laparoscopic DHR but is associated with increased index cost.