Current National Practice Patterns for Management of Ventral Abdominal Wall Hernia: A Population Based Study

L M Funk, MD, MPH, Kyle A Perry, MD, Vimal K Narula, MD, Dean J Mikami, MD, W Scott Melvin, MD

The Ohio State University

Introduction: The health care burden related to the management of ventral hernias is substantial with more than 3 billion dollars in expenditures annually in the U.S. alone. Previous studies have suggested that the utilization of laparoscopic mesh repair for incisional hernia remains relatively low; however, national case volume estimates for all types of abdominal wall hernias (umbilical, incisional and other ventral) have not been reported since these procedure codes were instituted in 2008. We performed a population-based analysis to estimate the national volume of elective ventral hernia surgery, identify the proportion of laparoscopic versus open approaches, and compare the cost and length of stay for each approach.

Methods and Procedures: 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 ventral hernia repair in the U.S. in 2009 and 2010. International Classification of Disease codes were used to identify the appropriate procedure codes. Cases that included major abdominal or pelvic operations, other than lysis of adhesions and/or small bowel resections, were excluded. Details of the surgical approach, including laparoscopic versus open technique and whether mesh was used were examined. National estimates of surgical volume were generated, and length of stay and total hospital charges were compared for laparoscopic versus open repairs.

Results: 110,051 elective umbilical, incisional and ventral hernia repairs were included in the analysis. 72.1% (n=80,973) of cases were incisional hernia repairs, while umbilical hernia repairs comprised only 6.9% (n=7,788) of the cohort. A laparoscopic approach was utilized in 26.6% (n=29,870) of cases, including 20.6% of umbilical hernias, 26.5% of incisional hernias, and 29.1% of other ventral hernias. Mesh was placed in 85.8% (n=96,265) of cases, including 50.0% (n=3,841) of umbilical hernia repairs and 90.1% (n=72,973) of incisional hernia repairs. There were no statistically significant differences in the use of laparoscopy or mesh between 2009 and 2010. Length of stay and total hospital charges were significantly lower for laparoscopic versus open umbilical, incisional and other ventral hernia repairs (p values all <.001). The average total hospital charge was $32,064 per admission for laparoscopic repairs compared to $37,377 for open repairs (p value<.001). Total hospital charges during this two year period approached 4 billion dollars ($936 million for laparoscopic repair versus $3 billion for open repair).

Conclusions: The utilization of laparoscopy for elective abdominal wall hernia repair remains low in the U.S. Only one-quarter of patients underwent laparoscopic umbilical, incisional or other ventral hernia repair in both 2009 and 2010 despite the fact that a laparoscopic approach was associated with a shorter hospitalization and lower inpatient cost. 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 imperative.

Session: Podium Presentation

Program Number: S016

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