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Ventral and incisional hernia: the cost of comorbidities and complications

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Abstract

Introduction

Ventral and incisional hernia repair (VIHR) is among the most frequently performed abdominal operations with significant incidence of postoperative complications and readmissions. Payers are targeting increased “value” of care through improved outcomes and reduced costs. Cost data in clinically relevant terms is still rare. This study aims to identify hospital costs associated with clinically relevant factors in order to facilitate strategies by surgeons to enhance the value of VIHR.

Methods

An IRB-approved retrospective review of VIHRs performed at the University of Kentucky from April 2009 through September 2013 was conducted. NSQIP clinical data and hospital cost data were matched. Operating room (ORC), total encounter (TEC), and 90-day postdischarge (90PDC) hospital costs were analyzed relative to clinical variables using non-parametric tests.

Results

In total 385 patients that underwent VIHR during the time period were included in the analyses. Considering all VIHRs, median [interquartile range (IQR)] ORC was $6900 ($5600–$10,000); TEC was $10,700 ($7500–$18,600); and 90PDC was $0 ($0–$800). Compared to all VIHRs, ASA Class ≥ 3 was associated with increased ORC and TEC (p < .001), and 90PDC (p < .01). Preoperative open wound was associated with increased ORC and TEC (p < .001). Numerous operative variables were associated with both increased ORC and TEC. Wound Class > 1 was associated with increased ORC and TEC (p < .001) and 90PDC (p < .01). Inpatient occurrence of any complication was associated with increased TEC and 90PDC (p < .001).

Conclusions

ASA Class ≥ 3, Wound Class > 1, open abdominal wound, and postoperative complications significantly increase costs. Although the hospital encounter represents the majority of the cost associated with VIHR, additional costs are incurred during the 90-day postoperative period. An appreciation of global costs is essential in developing alternative payment models for hernia in order to provide the greatest value in hernia care.

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Acknowledgements

The authors acknowledge and express their gratitude for the expert work of the NSQIP nurses, Devauna Riley, RN, and Roseanna Adair, RN, and the financial analyst, Daniel Heidemann, MBA, in generating the data used in this study. This work was supported in part by a grant from Life Cell.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, C 225, Chandler Medical Center, 800 Rose Street, Lexington, KY, 40536, USA

    Margaret A. Plymale & J. Scott Roth

  2. University of Kentucky College of Medicine, Lexington, KY, USA

    Ranjan Ragulojan

  3. Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA

    Daniel L. Davenport

Authors
  1. Margaret A. Plymale
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  2. Ranjan Ragulojan
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  3. Daniel L. Davenport
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  4. J. Scott Roth
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Correspondence to J. Scott Roth.

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Disclosures

Dr. Margaret A. Plymale, Ranjan Ragulojan, and Dr. Dan Davenport have no conflicts of interest or financial ties to disclose. Dr. Roth is a speaker for Bard, has grants with Bard, Life Cell, Gore, and MTF, and is a consultant for LifeCell.

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Plymale, M.A., Ragulojan, R., Davenport, D.L. et al. Ventral and incisional hernia: the cost of comorbidities and complications. Surg Endosc 31, 341–351 (2017). https://doi.org/10.1007/s00464-016-4977-8

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