BACKGROUND: Component separation technique (CST) has traditionally been performed using an open approach to repair complex abdominal wall hernias. However, major wound morbidities may ensue from the large lipocutaneous skin flaps. Minimally invasive endoscopic approaches have recently been described. It is unclear if the additional cost of endoscopic instruments outweighs any clinical benefits gained from avoiding skin flap related wound morbidity. We report the economic impact of open versus endoscopic component separation in complex abdominal wall reconstruction.
METHODS: All patients undergoing open and endoscopic CST between 2005 and 2009 by a single surgeon at Case Medical Center were retrospectively identified. Length of stay and financial data were obtained for the primary admission. Direct and Indirect costs were evaluated. Direct costs were itemized as: operating room supplies/time, anesthesia, ICU, floor care, laboratory, imaging, pharmacy and supportive therapy. Median and interquartile ranges (IQR) were evaluated by Wilcoxon rank sum test with a p-value of <0.05 considered significant.
RESULTS: Forty-three patients were identified. One mortality in the open group on post-operative day three was not analyzed leaving 21 patients in each group. There was a two day difference in hospital length of stay between open and endoscopic CST (p-value 0.06). Direct costs were higher in the open [$15,537] compared to the endoscopic [$7,461] patients (p-value 0.14). Indirect costs were also higher in the open group [$12,638 vs $6,340] (p-value 0.13). No difference was found in the subgroups of itemized direct costs (see Table 1).
Table 1: Length of Stay and Cost Analysis For Open Versus Endoscopic Component Separation In Complex Abdominal Wall Reconstruction (2005-2009)
| Variable | Open CST (IQR) [n=21] | Endo CST (IQR) [n=21] | p-value |
| Length of Stay (days) | 9 (6 – 18) | 7 (6 – 8) | 0.06 |
| Direct Costs ($) | 15,537 (6,385 – 27,072) | 7,461 (6,760 – 11,413) | 0.14 |
| Operating Room Supplies | 1,660 (708 – 6,736) | 1,512 (1,094 – 3,643) | 0.85 |
| Operating Room time | 1,874 (1,764 – 2,072) | 1,910 (1,720 – 2,072) | 0.76 |
| Anesthesia | 743 (660 – 830) | 767 (718 – 808) | 0.46 |
| SICU | 4,830 (2,352 – 13,753) [n=10] | 1,538 (1,264 – 1,835) [n=6] | 0.14 |
| Floor Care | 2,823 (1,807 – 3,514) | 2,145 (1,795 – 2,551) | 0.16 |
| Laboratory | 304 (131 – 687) | 179 (54 – 328) | 0.09 |
| Imaging | 639 (103 – 1,574) [n=17] | 310 (211 – 453) [n=15] | 0.46 |
| Pharmacy | 1,352 (682 – 4,586) | 735 (413 – 1,336) | 0.08 |
| Supportive therapy | 270 (123 – 1,891) [n=20] | 152 (26 – 353) [n=18] | 0.07 |
| Indirect Costs ($) | 12,638 (5,468 – 24,186) | 6,340 (5,714 – 9,392) | 0.13 |
CONCLUSIONS: Use of endoscopic component separation technique for complex abdominal wall reconstruction decreased length of stay without increasing hospital costs. Lower overall direct and indirect costs were noted in the endoscopic component separation group with the largest differences in laboratory, pharmacy and supportive therapy direct costs.
Session: Podium Presentation
Program Number: S024