The effect of surgical approach on opioid prescription rates for outpatient ventral hernia repair

BACKGROUND: Reducing the use of perioperative opioids in outpatient ventral hernia repair (VHR) has potential to limit negative side effects and the risk of opioid dependence. The effect of operative approach on opioid prescription in VHR is incompletely understood. Our objective is to compare rates of opioid prescription among robotic-assisted (RVHR), laparoscopic (LVHR), and open ventral hernia repair (OVHR). METHODS: A retrospective cohort study was conducted using a United States insurance claims database of outpatient VHR from 2018 to 2022. The cohort was divided into two groups: hernias coded as ventral or incisional and those coded as umbilical, epigastric, or spigelian. Opioid prescription fills were assessed at postoperative day (POD)0-14, POD15-30, and POD90-180. Surgical approaches were compared after propensity score matching (PSM) using logistic regression. RESULTS: 22,899 incisional/ventral hernia repairs (9.4% RVHR, 53.4% LVHR, and 37.2% OVHR) and 40,407 umbilical/epigastric/spigelian hernia repairs (4.3% RVHR, 21.5% LVHR and 74.1% OVHR) were included. In the incisional/ventral hernia group, RVHR and LVHR had similar opioid prescription rates POD0-14, but RVHR patients were less likely to fill opioids POD15-30 (OR = 0.65, p = 0.026). RVHR patients were also less likely to fill opioids POD15-30 (OR = 0.54, p = 0.017) relative to OVHR. In the umbilical/epigastric/spigelian group, RVHR patients were less likely to fill opioids than LVHR at POD15-30 (OR = 0.60, p = 0.033) and at POD90-180 (OR = 0.71, p = 0.021). CONCLUSIONS: RVHR was associated with fewer opioid prescriptions between POD15-30 relative to other operative approaches for ventral/incisional hernia. Along with multimodal analgesia and evidence-based prescription practices, the effect operative approach on opioid prescription should be considered.