Replacement of Ventral Hernia Working Group Grading System with 3-level Grading System Results in 1 Million Dollar Cost Reduction

Rishi Megha, MD, Braden Pachall, Paul Szotek, MD. Indiana University Health

Introduction: The choice of mesh for complex ventral hernia repair is a challenge faced by all general surgeons out of concerns for Surgical Site Occurrence (SSO).  In an effort to guide pre-operative prediction of SSOs and mesh selection, the Ventral Hernia Working Group (VHWG) convened and developed a 4 level grading system.  Based on the VHWG grading system, a surgeon can choose between mesh types based on the risk of SSO.  In 2012 Kanters, et. al. published their modified 3-level grading scale to predict SSO.  Based on this new scale there was a shift from the choice of biologic mesh to synthetic mesh.  This study evaluated the monetary impact at a single institution based on a switch from the original VHWG grading system to the 3-level grading system in 2013.

Methods and Procedures: A retrospective review of prospectively collected complex ventral hernia patients was performed on a cohort from February 2012 to August 2015.  In order to analyze the data, we developed a outcomes dashboard for our institution that can be used to compare cost and other parameters within our institution as a single institution quality measure. 

Results: Prior to 2013 all patients were evaluated based on the VHWG grading scale and all received biologic mesh implantation.  After the switch to the 3-level grading system all patients received synthetic mesh.  Utilizing the IU Surgical Materials Dashboard, we evaluated the ICU Length of stay, the hospital length of stay, and the facility cost of repairs.  The 3-level grading system in 2013 resulted in a decrease in the average ICU LOS from 6.5 to 3.5 Days, the average hospital LOS from 10.3 to 7.97 days, and a decrease in average facility cost from $59,000 per biologic mesh case to $34, 000 for synthetic mesh.  Based on the cost data we analyzed, had we not implemented the 3-level system in 2013, it would have cost our hospital system approximately 1 million dollars more in facility cost to perform abdominal wall reconstructions using biologic mesh in this population.

Conclusion: The 3-level hernia grading system for complex ventral hernia repair results in a significant shift in the type of mesh chosen for procedures and ultimately a significant cost reduction for the facility.  The development of an institutional database/dashboard at Indiana University Health for surgeons to review their cases in real time can guide process improvement and result in a significant cost savings for the system.

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