Chao Song, MPH1, Emelline Liu, MSHS1, Lizheng Shi, PhD2, Daniel Marcus, MD3. 1Intuitive Surgical, 2Tulane Univeristy, 3Marina Del Rey / Cedars Sinai Medical Center
Objectives: Ventral hernia repairs have been widely preformed in both inpatient and outpatient setting. The aim of this study is to explore the clinical and economic benefits of outpatient elective ventral hernia repairs (EVHRs) compared with inpatient EVHRs for obese patients.
Methods: Obese (BMI≥30) Patient s with ICD-9-CM procedure codes (53.4x, 53.5x, 53.6x ) were identified from Premier Perspective Database (Premier) from January 2013 to September 2015. Patients age≥18 having elective ventral repairs were included. Patients whose primary procedure were not ventral hernia repairs or had gastrointestinal tract resections were excluded. An 8-digitalto-4-digital Greedy propensity score matching (PSM) approach was used to compare outcomes between inpatient and outpatient. Patient socio-demographic, clinical characteristics, hospital level factors were applied to generate propensity score. Intraoperative complication and postoperative complication prior discharge, blood transfusion rate, conversion rate, patient controlled analgesia/PCA use and morphine equivalent dosage, length of stay, operation room(OR) time, and inflation adjusted total cost during hospitalization between inpatient and outpatient were assessed after matching.
Results: The study included 8537 outpatient EVHR cases and 6442 inpatient EVHR cases during January 2013-September 2015. Compared with outpatient cases, inpatient cases were older, with Medicare, with higher comorbidity score, more morbid obese, more likely to be female, and more likely to have gangrene or obstruction, adhesiolysis or myocutaneous flap. (P<.01)
A total of 2640 (16.4%) cases were matched by strict greedy PSM. No statistical difference was found between inpatient and outpatient cases among selected characteristics. Compared with inpatient cases, outpatient ventral hernia repairs were associated with significant lower complication rate, lower blood transfusion rate, conversion rate, shorter OR time, lower patient controlled analgesia(PCA) and PCA morphine equivalent dosage and lower total cost during hospitalization. Details were shown in Table 1.
Conclusion: Compared with inpatients, elective ventral hernia repairs in outpatients is associated with better clinical and economic outcomes among obese population. Additionally, the study found that the opportunity of potential shifting from inpatient to outpatient care exists, even for the obese patients to whom the ventral hernia repairs were relatively complex.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80176
Program Number: P020
Presentation Session: Poster (Non CME)
Presentation Type: Poster