Economic analysis of the robotic approach to inguinal hernia versus laparoscopic: is it sustainable for the healthcare system?

INTRODUCTION: There has been a rapid proliferation of the robotic approach to inguinal hernia, mainly in the United States, as it has shown similar outcomes to the laparoscopic approach but with a significant increase in associated costs. Our objective is to conduct a cost analysis in our setting (Spanish National Health System). MATERIALS AND METHODS: A retrospective single-center comparative study on inguinal hernia repair using a robotic approach versus laparoscopic approach. RESULTS: A total of 98 patients who underwent either robotic or laparoscopic TAPP inguinal hernia repair between October 2021 and July 2023 were analyzed. Out of these 98 patients, 20 (20.4%) were treated with the robotic approach, while 78 (79.6%) underwent the laparoscopic approach. When comparing both approaches, no significant differences were found in terms of complications, recurrences, or readmissions. However, the robotic group exhibited a longer surgical time (86 ± 33.07 min vs. 40 ± 14.46 min, p < 0.001), an extended hospital stays (1.6 ± 0.503 days vs. 1.13 ± 0.727 days, p < 0.007), as well as higher procedural costs (2318.63 ± 205.15 € vs. 356.81 ± 110.14 €, p < 0.001) and total hospitalization costs (3272.48 ± 408.49 € vs. 1048.61 ± 460.06 €, p < 0.001). These results were consistent when performing subgroup analysis for unilateral and bilateral hernias. CONCLUSIONS: The benefits observed in terms of recurrence rates and post-surgical complications do not justify the additional costs incurred by the robotic approach to inguinal hernia within the national public healthcare system. Nevertheless, it represents a simpler way to initiate the robotic learning curve, justifying its use in a training context.

In vitro assessment of the effect of clavulanic acid at concentrations achieved in human serum on the bactericidal activity of amoxicillin at physiological concentrations against Staphylococcus aureus: implications for dosage regimens.

The effects on Staphylococcus aureus viability and beta-lactamase activity of concentrations that simulated those in human serum after a combined dose of 875 mg of amoxicillin and 125 mg of clavulanic acid were studied in an in vitro pharmacodynamic model. Six hours of preexposure to concentrations of the amoxicillin-clavulanic acid combination that were higher than the amoxicillin-clavulanic acid MIC led to a reduction of the initial inoculum of >90% and to a significant decrease of beta-lactamase activity versus those of the control even from 6 h, when concentrations were subinhibitory. The postantibiotic effect and post-beta-lactamase inhibitor effect contributed to these results.

Index of years of potential life lost in Mexico.

PIP: The index of years of potential life lost (IYPL) is calculated for the states of Mexico in comparison to that of Mexico as a whole. Based on deaths notified in 1985, standardized reasons for mortality and the IYPL were calculated for 5-year cohorts in 32 Mexican states. The IYPL was first calculated for the State of Aguascalientes, a small state in central Mexico, using the formula of Haenszel and Yerushalmy. Columns were generated showing 1) the middle point for each cohort, by calculating the semi-sum of the relative limits in each age category; 2) number of deaths subtracted from an arbitrary life expectancy of 70; 3) population of each cohort; 4) rate of general mortality for each cohort; 5) expected deaths the state had a mortality equal to the Mexican Republic; and 6) IYPL. Results for IYPL for all the Mexican states are tabulated, next to life expectancy, and standardized reason for mortality. The results are also plotted graphically on maps. While at first the 2 figures do not seem consistent, socioeconomic factors such as child mortality, occupational mortality, nutrition, and environmental sanitation can explain some of the discrepancies. Usually mortality rates and life expectancy are used to describe and compare health in different regions. IYPL has it uses, despite its simple calculation, because it can suggest ways to allocate resources according to health needs.^ieng

Perinatal mortality and the evolution of population in Mexico.

PIP: The study of perinatal mortality in Mexico is of considerable importance due to the natality rate presented by the country as a result of inefficient development. Women in reproductive age, very young or very late, contribute with high risk pregnancies. Classification of medical causes of perinatal mortality continues to be a problem because of inexact records and the multiplicity of circumstances that may provoke the same effects. The World Health Organization groups the causes of perinatal mortality as follows: congenital malformations; obstetric causes; and other causes, including chronic or acute illness of the mother, illnesses of pregnancy and childbirth. Perinatal mortality expresses the obstetric risks of the fetus and the newlyborn, that is of that period of life that precedes the beginning of the viability of the fetus. Good care at childbirth, prevention of toxemias, of arytoblastosis, the use of adequate procedures of resuscitation, and incubators are all effective factors in the prevention of deaths. Socioeconomic conditions, particularly those related to nutrition, physical status and education of the pregnant women also have an important role in the reduction of perinatal mortality causes. Even through these preventive aspects have been intensified in the whole Mexican territory, there continues to be a great difference in its implementation in rural zones where disperse human settlements exist with scarce communication. Fetal mortality in Mexico has declined markedly over the 1930-1975 period. Perinatal mortality also has declined, from 51-190/1000 in 1930 to 10-39/1000 liveborn in 1975.^ieng