Abstract
Purpose
Over 300,000 ventral hernia repairs (VHRs) are performed each year in the US. We sought to assess the economic burden related to ventral hernia recurrences with a focused comparison of those with the initial open versus laparoscopic surgery.
Methods
The Premier Alliance database from 2009 to 2014 was utilized to obtain patient demographics and comorbid indices, including the Charlson comorbidity index (CCI). Total hospital cost and resource expenses during index laparoscopic and open VHRs and subsequent recurrent repairs were also obtained. The sample was separated into laparoscopic and open repair groups from the initial operation. Adjusted and propensity score matched cost outcome data were then compared amongst groups.
Results
One thousand and seventy-seven patients were used for the analysis with a recurrence rate of 3.78 %. For the combined sample, costs were significantly higher during recurrent hernia repair hospitalization ($21,726 versus $19,484, p < 0.0001). However, for index laparoscopic repairs, both the adjusted total hospital cost and department level costs were similar during the index and the recurrent visit. The costs and resource utilization did not go up due to recurrence, even though these patients had greater severity during the recurrent visit (CCI score 0.92 versus 1.06; p = 0.0092). Using a matched sample, the total hospital recurrence cost was higher for the initial open group compared to laparoscopic group ($14,520 versus $12,649; p = 0.0454).
Conclusions
Based on our analysis, need for recurrent VHR adds substantially to total hospital costs and resource utilization. Following initial laparoscopic repair, however, the total cost of recurrent repair is not significantly increased, as it is following initial open repair. When comparing the initial laparoscopic repair versus open, the cost of recurrence was higher for the prior open repair group.
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Abbreviations
- VHR:
-
Ventral hernia repair
- VH:
-
Ventral hernia
- MIS:
-
Minimally invasive surgery/laparoscopic surgery
- LOS:
-
Length of stay
- CCI:
-
Charlson comorbidity index
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DD reports non-financial support from Medtronic during the conduct of the study. MG reports non-financial support from Medtronic during the conduct of the study, as well as personal fees from Covidien, grants from Davol, grants and personal fees from Gore outside the submitted work. MF reports no conflict of interest. NP reports no conflict of interest.
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All procedures performed were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Davila, D.G., Parikh, N., Frelich, M.J. et al. The increased cost of ventral hernia recurrence: a cost analysis. Hernia 20, 811–817 (2016). https://doi.org/10.1007/s10029-016-1515-5
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DOI: https://doi.org/10.1007/s10029-016-1515-5