Fayyaz A Mazari, MBBS, MRCS, MSc, K Thomas, MRCS, M M Yeung, MRCS, Muhammad H Shiwani, MBBS, FRCS, FCPS
Barnsley Hospital NHS Foundation Trust, Barnsley, United Kingdom.
AIM:
To assess our experience in laparoscopic repair of ventral and incisional hernia (LRVIH) and the cost effectiveness of providing this service in a district general hospital setting in the National Health Service.
METHODS:
This was a prospective study of all consecutive patients who underwent LRVIH performed by one surgeon during the two years study period. The site and size of the hernias were recorded and classified according to the European classification of primary and incisional abdominal wall hernias recommended by the European Hernia Society. The duration of surgery, length of hospital stay; and immediate and early complications were used to assess LRVH’s safety and early effectiveness. Costs were calculated from NHS payment by result (PBR) tariffs.
RESULTS:
Fifty patients with mean age of 56 years (95% Confidence Interval 52 to 60 years), mean weight of 90kg (95% Confidence Interval 85 to 96kg) and mean BMI of 32.2 (95% Confidence Interval 30.3 to 34.2kg), were offered to take part in the study and included after consenting. Twenty four patients had incisional hernias, fourteen recurrent incisional hernias and twelve patients had primary ventral hernias. Nine patients had multiple abdominal wall defects at surgery.
The median size of defects was 25cm2 (95% Confidence Interval 20 to 35 cm2; Interquartile range 16 to 54cm2). Epigastrium was the most common site (49%). The median operating time was 60minutes (95% Confidence Interval 60 to 90minutes; Interquartile range 55 to 90minutes); median length of stay was 1 bed day (Interquartile range 1 to 1.25days). Seven patients suffered morbidity, including three seromas, two conversions to open procedures and two suffered respiratory complications.
Median cost of repair was £1318 (95% Confidence Interval £1175 to £1501; Interquartile range £1172 to £1693). Median income to hospital according to PBR tariffs was £1747 (95% Confidence Interval £1415 to £1747; Interquartile range £1163 to £2422). Median cost of treatment for patients with then those with W1 defects (<4cm wide) was £1339 (95% Confidence Interval £1175 to £1894; Interquartile range £1175 to £1805); for W2 (4cm to 10cm wide) defects was £1175 (95% Confidence Interval £1054 to £1362; Interquartile range £972 to £1578); and for W3 defects (>10cm wide) was £1585 (95% Confidence Interval £1390 to £37376; Interquartile range £1423 to £3252) respectively. This difference was statistically significant (Kruskal Wallis test, p=0.012). Cost for repairing defects >25cm2 in area was higher (Median £1505, 95% Confidence Interval £1366 to £1921, Interquartile range £1330 to 2014) compared to smaller defects (Median £1175, 95% Confidence Interval £1034 to £1288, Interquartile range £966 to £1493) and this difference was statistically significant (Mann Whitney test, p=0.002). Repair of W3 and >25cm2 defects generated a loss on the current NHS tariffs; while smaller hernias were cost neutral.
CONCLUSION:
The early experience of our institute in LRVIH shows that it is a safe and effective option to offer to patients. However, tariffs for larger defects need reconsideration to make them cost effective.
Session: Poster Presentation
Program Number: P304