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Concomitant open ventral hernia repair: what is the financial impact of performing open ventral hernia with other abdominal procedures concomitantly?

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Abstract

Background

Open ventral hernia repair (VHR) is often performed in conjunction with other abdominal procedures. Clinical outcomes and financial implications of VHR are becoming better understood; however, financial implications of concomitant VHR during other abdominal procedures are unknown. This study aimed to evaluate the financial implications of adding VHR to open abdominal procedures.

Methods

This IRB-approved study retrospectively reviewed hospital costs to 180-day post-discharge of standalone VHRs, isolated open abdominal surgeries (bowel resection or stoma closure, removal of infected mesh, hysterectomy or oophorectomy, panniculectomy or abdominoplasty, open appendectomy or cholecystectomy), performed at our institution from October 1, 2011 to September 30, 2014. The perioperative risk data were obtained from the local National Surgery Quality Improvement Program (NSQIP) database, and resource utilization data were obtained from the hospital cost accounting system.

Results

345 VHRs, 1389 open abdominal procedures as described, and 104 concomitant open abdominal and VHR cases were analyzed. The VHR-only group had lower ASA Class, shorter operative duration, and a higher percentage of hernias repaired via separation of components than the concomitant group (p < 0.001). The median hospital cost for VHR-alone was $12,900 (IQR: $9500–$20,700). There were significant increases to in-hospital costs when VHR was combined with removing an infected mesh (63%) or with bowel resections or stoma closures (0.7%). The addition of VHR did not cause a significant change in 180-day post-discharge costs for any of the procedures.

Conclusions

This study noted decreased costs when combining VHR with panniculectomy or abdominoplasty and hysterectomy or oophorectomy. For removal of infected mesh and bowel resection or stoma closure, waiting, when feasible, is recommended. Given the impending changes in financial reimbursements in healthcare in the United States, it is prudent that future studies evaluate further the clinical and fiscal benefit of concomitant procedures.

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Authors and Affiliations

  1. University of Kentucky Division of General Surgery, Lexington, KY, USA

    Vashisht Madabhushi, Margaret A. Plymale & John Scott Roth

  2. University of Kentucky Department of Surgery, Lexington, KY, USA

    Daniel L. Davenport

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

    Sara Johnson & Alex Wade

  4. 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

    John Scott Roth

Authors
  1. Vashisht Madabhushi
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  2. Margaret A. Plymale
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  3. John Scott Roth
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  4. Sara Johnson
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  5. Alex Wade
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  6. Daniel L. Davenport
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Corresponding author

Correspondence to John Scott Roth.

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Disclosures

Dr. Roth is a speaker for Bard, has grants with Bard, Life Cell, Gore, and MTF, and is a consultant for Life Cell. Dr. Madabhushi, Dr. Davenport, Dr. Plymale, Dr. Johnson, and Mr. Wade have no financial interests to disclose.

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Madabhushi, V., Plymale, M.A., Roth, J.S. et al. Concomitant open ventral hernia repair: what is the financial impact of performing open ventral hernia with other abdominal procedures concomitantly?. Surg Endosc 32, 1915–1922 (2018). https://doi.org/10.1007/s00464-017-5884-3

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  • DOI: https://doi.org/10.1007/s00464-017-5884-3

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