Adam S Weltz, MD, Justin Turcotte, MBA, Udai S Sibia, MD, Evgenii Zakharov, MD, Nan Wu, MD, Timothy R Turner, PhD, Adrian Park, MD, Hamid R Zahiri, DO, Igor Belyansky, MD. Anne Arundel Medical Center
Introduction: Open abdominal wall reconstruction (AWR) was previously one of the only methods available to treat massive ventral hernia with loss of domain. As the trend towards minimally invasive approaches to AWR has gained momentum we have recognized several advantages for both the patient and hospital system. We set out to identify the impact of MIS (laparoscopy and robotics) on our AWR program by performing an economic analysis of our program before and after the institution of minimally invasive AWR.
Methods: We retrospectively reviewed inpatient hospital costs and economic factors for a consecutive series of 104 AWR cases that utilized separation of components technique (57 open, 38 laparoscopic, 9 robotic). Patients were placed into two groups by date of procedure. Group 1 (G1) was July 2012- June 2015 which included 52 open cases. Group 2 (G2) was July 2015 to August 2016 which included 47 cases (5 open, 48 laparoscopic, 9 robotic).
Results: Our G1 patients’ mean age was 54.2 years as compared to G2 patients’ 54.1 years. The groups’ ASA scores were also equivalent at 2.5 and 2.3 respectively (p=0.28). Patients in the G1 group exhibited a mean BMI of 34.7 as compared to 32.1 in G2 (p=0.059); however, EBL was higher in G1 as compared to G2 (161 mL vs 69.3 mL, p <0.001). Mean defect areas were larger in the G1 group (293.2 cm2 vs 206.7 cm2, p=0.008) although mesh size placed were similar (758.8 cm2 for G1 vs 782.9 cm2 for G2, p=0.73). Total OR time (min), procedure times (min) and PACU minutes did not differ significantly between groups (279.0 vs 272.1, p=0.70; 234.6 vs 232.9, p=0.91; and 176.6 vs 151.7, p=0.11, respectively). Operating room supply costs for G2 patients were slightly higher on average per case (an increase of $1,704 over G1), but the increase was not statistically significant; p=0.15. Length of Stay (LOS) decreased significantly (5.3 days vs 1.4 days; p= <0.001), as did Total Cost of the entire hospitalization ($20,924 vs $12,295; p= <0.001).
Conclusions: Despite an increase in operating room supply costs, transition to performing MIS AWR in cases that were previously done through an open approach dramatically decreased LOS and translated into significant overall total cost savings.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80344
Program Number: S050
Presentation Session: Ventral Hernias
Presentation Type: Podium
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