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Current national practice patterns for inpatient management of ventral abdominal wall hernia in the United States

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Abstract

Background

The health-care burden related to ventral hernia management is substantial, with more than 3 billion dollars in expenditures annually in the US. Previous studies have suggested that the utilization of laparoscopic repair remains relatively low although national volume estimates have not been reported. We sought to estimate the inpatient national volume of elective ventral hernia surgery and characterize the proportion of laparoscopic versus open operations.

Methods

We analyzed data from the Nationwide Inpatient Sample to identify adults with a diagnosis of an umbilical, incisional, or ventral hernia who underwent an elective inpatient repair between 2009 and 2010. Cases that involved other major abdominal or pelvic operations were excluded. Covariates included patient demographics, surgical approach, and use of mesh. National surgical volume estimates were generated and length of stay and total hospital charges were compared for laparoscopic versus open repairs.

Results

A total of 112,070 ventral hernia repairs were included in the analysis: 72.1 % (n = 80,793) were incisional hernia repairs, while umbilical hernia repairs comprised only 6.9 % (n = 7,788). Laparoscopy was utilized in 26.6 % (n = 29,870) of cases. Mesh was placed in 85.8 % (n = 96,265) of cases, including 49.3 % (n = 3,841) of umbilical hernia repairs and 90.1 % (n = 72,973) of incisional hernia repairs. Length of stay and total hospital charges were significantly lower for laparoscopic umbilical, incisional, and “other” ventral hernia repairs (p values all <0.001). Total hospital charges during this 2-year period approached 4 billion dollars ($746 million for laparoscopic repair; $3 billion for open repair).

Conclusions

Utilization of laparoscopy for elective abdominal wall hernia repair remains relatively low in the US despite its excellent outcomes. Given the substantial financial burden associated with these hernias, future research focused on preventing the development and optimizing the surgical treatment of ventral abdominal wall hernias is warranted.

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Disclosures

Drs. Vimal K. Narula and Dean J. Mikami have received honoraria for serving as speakers for Covidien. Drs. Luke M. Funk, Kyle A. Perry, and W. Scott Melvin have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA

    Luke M. Funk, Kyle A. Perry, Vimal K. Narula & Dean J. Mikami

  2. Division of General and Gastrointestinal Surgery, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    W. Scott Melvin

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  1. Luke M. Funk
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  2. Kyle A. Perry
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  3. Vimal K. Narula
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Correspondence to Luke M. Funk.

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Funk, L.M., Perry, K.A., Narula, V.K. et al. Current national practice patterns for inpatient management of ventral abdominal wall hernia in the United States. Surg Endosc 27, 4104–4112 (2013). https://doi.org/10.1007/s00464-013-3075-4

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