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National epidemiologic trends (2008–2018) in the United States for the incidence and expenditures associated with incisional hernia in relation to abdominal surgery

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Abstract

Purpose

It is unknown whether the trend of rising incisional hernia (IH) repair (IHR) incidence and costs until 2011 currently persists. We aimed to evaluate how the IHR procedure incidence, cost and patient risk-profile have changed over the last decade relative to all abdominal surgeries (AS).

Methods

Repeated cross-sectional analysis of 38,512,737 patients undergoing inpatient 4AS including IHR within the 2008–2018 National Inpatient Sample. Yearly incidence (procedures/1,000,000 people [PMP]), hospital costs, surgical and patient characteristics were compared between IHR and AS using generalized linear and multinomial regression.

Results

Between 2008–2018, 3.1% of AS were IHR (1,200,568/38,512,737). There was a steeper decrease in the incidence of AS (356.5 PMP/year) compared to IHR procedures (12.0 PMP/year) which resulted in the IHR burden relative to AS (2008–2018: 12,576.3 to 9,113.4 PMP; trend difference P < 0.01). National costs averaged $47.9 and 1.7 billion/year for AS and IHR, respectively. From 2008–2018, procedure costs increased significantly for AS (68.2%) and IHR (74.6%; trends P < 0.01). Open IHR downtrended (42.2%), whereas laparoscopic (511.1%) and robotic (19,301%) uptrended significantly (trends P < 0.01). For both AS and IHR, the proportion of older (65–85y), Black and Hispanic, publicly-insured, and low-income patients, with higher comorbidity burden, undergoing elective procedures at small- and medium-sized hospitals uptrended significantly (all P < 0.01).

Conclusion

IH persists as a healthcare burden as demonstrated by the increased proportion of IHR relative to all AS, disproportionate presence of high-risk patients that undergo these procedures, and increased costs. Targeted efforts for IH prevention have the potential of decreasing $17 M/year in costs for every 1% reduction.

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Acknowledgements

AJRD had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

None.

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Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA

    A. J. Rios-Diaz, M. P. Morris, A. N. Christopher, V. Patel, R. B. Broach & J. P. Fischer

  2. Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA

    A. J. Rios-Diaz & A. N. Christopher

  3. Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA

    B. T. Heniford

  4. Center for Clinical Epidemiology and Biostatistics (CCEB), University of Pennsylvania, Philadelphia, PA, USA

    J. Y. Hsu

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  1. A. J. Rios-Diaz
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  4. V. Patel
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Contributions

Conception and design of the study: AJRD, JYH, RBB, JPF. Data acquisition: AJRD, MPM, VP, JYH, JPF. Data analysis: AJRD, JYH, MPM. Data interpretation: AJRD, MPM, ANC, VP, RBB, BTH, JYH, JPF. Drafting of the article: AJRD, MPM, ANC, VP, RBB, BTH, JPF. Critical revisions of the manuscript: AJRD, MPM, ANC, VP, RBB, BTH, JYH, JPF.

Corresponding author

Correspondence to J. P. Fischer.

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Conflict of interest

During the study period, Dr. Fischer received funding and consulting fees from Becton–Dickinson, Baxter, Integra, and WL Gore. Dr. Heniford received funding and consulting fees from Allergan, and WL Gore. Remaining authors have no more disclosures.

Human and animal rights and Informed consent

This study was deemed exempt from full review and informed consent by the institutional review board of the University of Pennsylvania. All the data used in this study are preexisting, publicly available and deidentified.

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10029_2022_2644_MOESM1_ESM.docx

Supplemental Table 1: Trends in procedure counts, rates per million population (PMP), median cost per patient (in 2018 USD), and aggregate national costs (in millions) in a nationally representative sample of patients undergoing inpatient abdominal surgery, by type of procedure. Supplemental Table 2 Temporal changes in comorbidities in a nationally representative sample patients undergoing abdominal procedures between 2008–2018. Supplemental Table 3 Temporal changes in comorbidities in a nationally representative sample patients undergoing incisional hernia repair procedures between 2008–2018. Supplemental Table 4 Trend in hospitalizations, rates, patient, and aggregate costs by type of procedure in a nationally representative sample of patients undergoing abdominal surgery between 2008–2018 (DOCX 87 KB)

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Rios-Diaz, A.J., Morris, M.P., Christopher, A.N. et al. National epidemiologic trends (2008–2018) in the United States for the incidence and expenditures associated with incisional hernia in relation to abdominal surgery. Hernia 26, 1355–1368 (2022). https://doi.org/10.1007/s10029-022-02644-4

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