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Surgical Endoscopy

, Volume 32, Issue 5, pp 2381–2386 | Cite as

Impact of incisional hernia development following abdominal operations on total healthcare cost

  • Vamsi V. Alli
  • Jianying Zhang
  • Dana A. Telem
Article

Abstract

Background

Introduction of the category III CPT code (0437T) for prophylactic mesh augmentation (PMA) highlights efforts to reduce incisional hernia (IH). PMA’s value in the context of value-based care requires understanding both the cost of IH development and the savings from prevention. We hypothesized large healthcare costs with IH development. Appreciating which subsets of patients are at highest risk for IH, and the subsets who have the costliest care is essential in targeting interventions for hernia prevention.

Methods

Retrospective cohort study utilizing data from Truven Health Analytic MarketScan Commercial Claims and Encounters Database from calendar years 2011–2014. Adults undergoing open abdominal operations with continued enrollment 3-year post-surgery were included. Inpatient and outpatient claims were tracked over 3 years to identify IH. Quantile regression estimated the association between conditional distribution of total cost and IH. A generalized linear model with gamma distribution estimated the association of conditional mean of total cost and IH. Models were adjusted for confounding cost covariates (e.g., age, gender, obesity, smoking, cancer).

Results

14,290 patients were identified, 1294 (9.1%) developed IH, 48% within 1-year, 33% at 1–2 years, and 19% at 2–3 years post-surgery. 515 underwent stoma creation, 4579 colon resection, 2263 liver/kidney, 3890 peritoneal, 3043 other (foregut, appendectomy, cholecystectomy). Rate of IH formation was 25, 13, 5.9, 6.3, and 6.3%, respectively. The difference in median expenditures for IH development versus no IH was ostomies: $26,098, colorectal: $21,211, liver/kidney: $23,811, peritoneal: $25,554, others: $28,870 (p < 0.0.01). IH within 1 year was more expensive than within 3 years in the following categories: colorectal ($16,034, p = 0.0385), liver/kidney ($27,145, p = 0.0004), and ostomy ($18,992, p = 0.0035).

Conclusion

IH is a common occurrence imposing significant healthcare burden. Higher costs occur when IH occurs within 1 year versus 3 years from the index-procedure. This highlights the importance of hernia prevention techniques and the question of whether temporizing closure adjuncts  are appropriate in high-risk patients.

Keywords

Incisional hernia Hernia prevention Prophylactic mesh augmentation Hernia phenotype Value-based care 

Notes

Compliance with ethical standards

Disclosures

Jianying Zhang works for Medtronic Healthcare Economics, Dr. Dana Telem serves as a consultant for Medtronic, Gore and Ethicon and receives research support from Cook and Surgiquest. Dr. Vamsi Alli has no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Rahbari NN et al (2009) Current practice of abdominal wall closure in elective surgery—Is there any consensus? BMC Surg 9:8CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Dasari M, Wessel CB, Hamad GG (2016) Prophylactic mesh placement for prevention of incisional hernia after open bariatric surgery: a systematic review and meta-analysis. Am J Surg 212(4):615–622CrossRefPubMedGoogle Scholar
  3. 3.
    Fischer JP et al (2016) A risk model and cost analysis of incisional hernia after elective, abdominal surgery based upon 12,373 cases: the case for targeted prophylactic intervention. Ann Surg 263(5):1010–1017CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Fink C et al (2014) Incisional hernia rate 3 years after midline laparotomy. Br J Surg 101(2):51–54CrossRefPubMedGoogle Scholar
  5. 5.
    Poulose BK et al (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183CrossRefPubMedGoogle Scholar
  6. 6.
    Burger JW et al (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240(4):578–583; discussion 583–585PubMedPubMedCentralGoogle Scholar
  7. 7.
    Awaiz A et al (2015) Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Hernia 19(3):449–463CrossRefPubMedGoogle Scholar
  8. 8.
    Al Chalabi H et al (2015) A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg 20:65–74CrossRefPubMedGoogle Scholar
  9. 9.
    Diener MK et al (2010) Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg 251(5):843–856CrossRefPubMedGoogle Scholar
  10. 10.
    Bhangu A et al (2013) Systematic review and meta-analysis of prophylactic mesh placement for prevention of incisional hernia following midline laparotomy. Hernia 17(4):445–455CrossRefPubMedGoogle Scholar
  11. 11.
    Millbourn D, Wimo A, Israelsson LA (2014) Cost analysis of the use of small stitches when closing midline abdominal incisions. Hernia 18(6):775–780CrossRefPubMedGoogle Scholar
  12. 12.
    Wang XC et al (2017) Mesh reinforcement for the prevention of incisional hernia formation: a systematic review and meta-analysis of randomized controlled trials. J Surg Res 209:17–29CrossRefPubMedGoogle Scholar
  13. 13.
    Borab ZM et al. (2017) Does prophylactic mesh placement in elective, midline laparotomy reduce the incidence of incisional hernia? A systematic review and meta-analysis. Surgery 161:1149–1163CrossRefPubMedGoogle Scholar
  14. 14.
    Fischer JP et al (2016) A cost-utility assessment of mesh selection in clean-contaminated ventral hernia repair. Plast Reconstr Surg 137(2):647–659CrossRefPubMedGoogle Scholar
  15. 15.
    Carbonell AM et al (2013) Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg 217(6):991–998CrossRefPubMedGoogle Scholar
  16. 16.
    Majumder A et al (2016) Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs. Surgery 160(4):828–838CrossRefPubMedGoogle Scholar
  17. 17.
    Rosen MJ et al (2017) Multicenter, prospective, longitudinal study of the recurrence, surgical site infection, and quality of life after contaminated ventral hernia repair using biosynthetic absorbable mesh: The COBRA Study. Ann Surg 265(1):205–211CrossRefPubMedGoogle Scholar
  18. 18.
    López-Cano M et al (2014) PREBIOUS trial: a multicenter randomized controlled trial of PREventive midline laparotomy closure with a BIOabsorbable mesh for the prevention of incisional hernia: rationale and design. Contemp Clin Trials 39(2):335–341CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Vamsi V. Alli
    • 1
  • Jianying Zhang
    • 2
  • Dana A. Telem
    • 3
  1. 1.Department of SurgeryPenn State Hershey Medical CenterHersheyUSA
  2. 2.Medtronic, Minimally Invasive Therapies GroupMansfieldUSA
  3. 3.Department of SurgeryUniversity of Michigan Health SystemsAnn ArborUSA

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