Vashisht V Madabhushi, MD, Margaret A Plymale, DNP, RN, John S Roth, MD, Sara E Johnson, BS, Daniel L Davenport, PhD. University of Kentucky
Introduction: Open ventral hernia repair (VHR) is often performed in conjunction with other abdominal procedures. Clinical outcomes and financial implications of VHR are becoming better understood; however, financial implications of concomitant VHR during other abdominal procedures are unknown. This study aimed to evaluate the financial implications of adding VHR to unrelated open abdominal procedures.
Methods and Procedures: This IRB-approved study retrospectively reviewed hospital costs to 180 days post discharge of standalone open VHRs, isolated open abdominal surgeries (colostomy/ostomy reversal, removal of infected mesh, hysterectomy/oophorectomy, panniculectomy/abdominoplasty, fistula takedown, appendectomy/cholecystectomy), and same procedures performed in combination with VHR. The patient perioperative risk data was obtained from the local National Surgery Quality Improvement Program (NSQIP) database and resource utilization data was obtained from the hospital cost accounting system. Hospital costs involved direct and indirect costs. Procedures were performed at our institution from October 1, 2011, to September 30, 2014. Costs are reported as median US dollars (interquartile range).
Results: 334 VHRs, 1391 open abdominal surgeries as described, and 114 concomitant open abdominal and VHR cases were included in the data analyses. The VHR-only group had lower ASA Class (61% ≥ ASA III vs. 73%), lower wound class (17% ≥ 2 vs. 85%), shorter operative duration (160 minutes vs 223 minutes), and higher incidence of emergent cases (15% vs 5%) than the concomitant group (p < .001). The median hospital costs for VHR-alone was $12,700 (IQR: $9,400-$20,000). When the cost of adding VHR was compared to isolated open abdominal surgeries, there were significant increases to in-hospital costs when combined with removing an infected mesh (393%), panniculectomy/abdominoplasty (92%), fistula closure (57%), or hysterectomy/oophorectomy (40%). The dollar increases were significantly less than a stand-alone VHR ($12,700) except for colectomy/ostomy reversal (similar at 11,400) and for removal of infected mesh (much higher $23,200). The addition of VHR did not cause a significant change in 180 day post discharge costs for any of the procedures.
Conclusions: This study noted cost effectiveness of combining VHR with panniculectomy/abdominoplasty, fistula closure, appendectomy/cholecystectomy and hysterectomy/oophorectomy rather than waiting for a later stand alone VHR. For colectomy/ostomy reversal, the total costs were similar so staging should be purely a clinical decision. For removal of infected mesh, waiting is suggested from a purely cost rationale. Given the impending changes in financial reimbursements in healthcare in the United States, it is prudent that future studies evaluate further the clinical and fiscal benefit of concomitant procedures.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80234
Program Number: S049
Presentation Session: Ventral Hernias
Presentation Type: Podium