Sara E Johnson, BS, Margaret A Plymale, DNP, RN, Daniel L Davenport, PhD, Vashisht V Madabhushi, MD, Charlie S Tancula, John S Roth, MD. University of Kentucky
Introduction: Although the majority of patients experience no complications following open ventral and incisional hernia repair (VIHR), the incidence of postoperative surgical site infection (SSI) has been reported to be as high as 19% to 25%. Postoperative complications would be expected to be associated with an increased burden on outpatient resources, but little is known about the predictors of increased ambulatory costs following VIHR. The purpose of this study is to evaluate the financial impact of perioperative factors on outpatient resource utilization following VIHR.
Methods and Procedures: An IRB-approved retrospective review of clinical and cost data for patients that underwent VIHR was conducted. Surgery scheduling system query identified cases performed from October 1, 2011, through September 30, 2014; cases during which any concomitant procedures were performed with VIHR were excluded. A clinical and cost representation of cases was obtained by combining local National Surgical Quality Improvement Program (NSQIP) data and data from the hospital cost accounting and physician billing systems. Medical records for the 180 day postoperative time period were reviewed to identify complications and the number of ambulatory surgical office visits that occurred.
Results: Cost and clinical data was analyzed for 310 patients. Average patient age was 52 years (SD = 13.3), and 56% of the patients were female. The number of outpatient visits to the surgical office during the 180 postoperative time period varied from 0 to 18 [median = 2; interquartile range (IQR) = 1-3]. No preoperative characteristic was noted to be associated with increased number of office visits. CDC Wound Class > 1 was associated with increase of mean 1.4 visits (IQR: 0.5-2.3); p = .003. Intraoperative variables indicative of increased complexity of VHR such as component separation, longer duration of operation, and increased size of mesh utilized were also predictive of increased number of office visits (p < .001). Postoperative surgical site occurrences were associated with increased number of visits: infected seroma/seroma requiring drainage added a mean 2.3 visits (IQR: 1.3-3.3), p < .001; deep wound infection added a mean 3.9 visits (IQR: 1.9-5.9) p < .001.
Conclusions: Postoperative surgical site complications following VIHR add a significant burden for patients and to the outpatient surgical office. In an era in which improved quality and cost-efficiency has become imperative, measures to decrease risk of postoperative complications particularly for more complex VIHRs would be expected to decrease resource utilization and increase cost-effectiveness of care.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80392
Program Number: P054
Presentation Session: Poster (Non CME)
Presentation Type: Poster
