# New persistent opioid use following robotic-assisted, laparoscopic and open surgery inguinal hernia repair

## TL;DR

Robotic-assisted surgery for hernia repair is linked to lower long-term opioid use compared to laparoscopic and open methods.

## Contribution

This study is the first to compare long-term opioid use after robotic-assisted, laparoscopic, and open inguinal hernia repair using a national claims database.

## Key findings

- Robotic-assisted surgery was associated with lower odds of any opioid prescription fills compared to laparoscopic and open surgery.
- Laparoscopic and open surgery showed no significant difference in opioid use outcomes.
- High-dose opioid use was comparable across all surgical approaches.

## Abstract

Post-operative prescription opioid use is a known risk factor for persistent opioid use. Despite the increased utilization of robotic-assisted surgery (RAS) for inguinal hernia repair (IHR), little is known whether this minimally invasive approach results in less opioid consumption. In this study, we compare long-term opioid use between RAS versus laparoscopic (Lap) versus open surgery for IHR.

A retrospective cohort study of opioid-naïve patients who underwent outpatient primary IHR was conducted using the Merative™ MarketScan® (Previously IBM MarketScan®) Databases between 2016 and 2020. Patients not continuously enrolled 180 days before/after surgery, who had malignancy, pre-existing chronic pain, opioid dependency, or invalid prescription fill information were excluded. Among patients exposed to opioids peri-operatively, we assessed long-term opioid use as any opioid prescription fill within 90 to 180 days post-surgery. Secondary outcomes were controlled substance schedule II/III opioid fill, and high-dose opioid fill defined as > 50 morphine milligram equivalent per day. An Inverse-probability of treatment weighted logistic regression was used to compare outcomes between groups with p-value of < 0.05 considered statistically significant.

A total of 41,271 patients were identified (2070 (5.0%) RAS, 16,704 (40.5%) Lap, and 22,497 (54.5%) open surgery). RAS was associated with less likelihood of prescription fills for any opioid (OR 0.78, 95% CI 0.60 to 0.98 versus Lap; OR 0.67, 95% CI 0.52 to 0.85 versus open), and schedule II/III opioid (OR 0.74, 95% CI 0.56 to 0.96 versus Lap; OR 0.68, 95% CI 0.51 to 0.88 versus open), but comparable high-dose opioid fill (OR 0.95, 95% CI 0.54 to 1.55 versus Lap; OR 0.96, 95% CI 0.56 to 1.52 versus open). Lap and open surgery had no significant difference.

In this cohort of patients derived from a national commercial claims dataset, patients undergoing RAS had a decreased risk of long-term opioid use compared to laparoscopic and open surgery patients undergoing IHR.

The online version contains supplementary material available at 10.1007/s00464-024-11040-1.