Vamsi Alli, MD1, Jianying Zhang2, Jiejing Qin2, Dana Telem, MD, MPH3. 1Penn State Milton Hershey Medical Center, 2Analyst, Medtronic, 3University of Michigan
Background: The introduction by the AMA of a category III CPT code (0437T) for prophylactic mesh augmentation (PMA), highlights current efforts to reduce incisional hernia (IH). The value of PMA in the context of value based care requires an understanding of both the cost of development of IH as well as the cost savings accrued by its prevention. We hypothesize a large healthcare cost associated with IH development. More so, an understanding of which subsets of patients is not only at highest risk for IH, but carry the highest cost of care for IH is essential to determining targeted interventions for hernia prevention, including PMA.
Methods:A retrospective cohort study was performed utilizing data from the Truven Health Analytic MarketScan Commercial Claims and Encounters Database (CCE-DB) from calendar years (CY) 2011 to 2014. Adult patients undergoing open abdominal operations with continued enrollment in the healthcare plan for 3-years post surgery were included. Patient inpatient and outpatient claims were tracked over 3-years to identify IH. A quantile regression estimated the association between conditional distribution of total cost and IH. A generalized linear model with gamma distribution estimated the association of conditional mean of total cost and IH. Models were adjusted for confounding cost covariates (e.g. age, gender, obesity, smoking, cancer).
Results: Of the 14,290 identified patients, 1294(9.1%) developed IH – 48% occurred within 1-year, 33% at 1-2 years and 19% at 2-3 years after surgery. In total, 515 patients underwent stoma creation, 4,579 colon resection, 2,263 liver/kidney, 3,890 peritoneal and 3,043 other (foregut, appendectomy, cholecystectomy) operations. The rate of IH formation was 25%, 13%, 5.9%, 6.3% and 6.3%, respectively. The difference in median expenditures for patients who developed IH versus those that did not was $26,098 for ostomies, $21,211 for colorectal, $23,811 for liver/kidney, $25,554 for peritoneal and $28,870 for others (p<0.0.01). IH appearing within 1-year were significantly more expensive to treat than those appearing within 3-years in the following categories: colorectal ($16,034, p=0.0385), liver/kidney ($27,145, p=0.0004), and ostomy ($18,992, p=0.0385).
Conclusion: IH is a common occurrence which imposes a significant healthcare burden. Interestingly, expenditures are significantly higher when IH occurs within 1-year as opposed to 3-years from index procedure. This finding highlights the importance of hernia prevention techniques and raises the question of whether there is value to temporizing measures and closure adjuncts in high risk patients in order to delay the onset of IH.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80616
Program Number: S048
Presentation Session: Ventral Hernias
Presentation Type: Podium