Drivers and composition of hospitalization costs in patients undergoing laparoscopic tension-free hiatal hernia repair: A quantile regression study.

Abstract

<h4>Background</h4>Laparoscopic tension-free repair has become the standard surgical treatment for hiatal hernia because of its favorable clinical outcomes. However, the associated hospitalization costs vary considerably, driven by both patient complexity and technical factors. This study aimed to analyze the drivers and composition of hospitalization costs in patients undergoing laparoscopic tension-free hiatal hernia repair using a quantile regression approach.<h4>Methods</h4>A retrospective observational study was conducted among patients who underwent laparoscopic tension-free hiatal hernia repair at Beijing Chao-Yang Hospital, Capital Medical University, between 2020 and 2023. Clinical, demographic, and procedural data were extracted from electronic medical records. The primary outcome was total hospitalization cost; secondary outcomes included cost composition (diagnosis, treatment, nursing, medication, materials, and others) and postoperative recurrence. Quantile regression was used to identify factors associated with total hospitalization costs across the 10th-90th percentiles. Recurrence was examined using multivariable logistic regression.<h4>Results</h4>A total of 197 patients were included. Most were female (60.4%) and aged ≥65 years (54.8%). Material costs represented the largest share of total hospitalization expenses in every year (>58%). In quantile regression, mesh fixation with absorbable sutures versus tackers was associated with lower costs across all quantiles (β = -11,671 to -8,372; all P ≤ .003). Length of stay was positively associated with costs from the 10th to the 70th quantile (β = 623-917; all P ≤ .032). Intensive care unit use increased costs predominantly in the lower-mid quantiles (q10-q40; β = 2,577-4,301). Postoperative recurrence occurred in 9 of 197 patients (4.6%) and had no independent predictors on multivariable analysis.<h4>Conclusion</h4>Hospitalization costs for laparoscopic tension-free hiatal hernia repair were largely driven by material expenditures. Absorbable suture fixation reduced costs across all quantiles without prolonging operative time, whereas longer length of stay increased costs, and intensive care unit use affected mainly the lower-mid range. Early recurrence was uncommon and had no independent predictors, supporting cost-conscious strategies that prioritize judicious fixation, discharge efficiency, and selective critical-care use, to be confirmed in prospective studies with standardized long-term outcomes.