Matthew R Pittman, MD, Dean J Mikami, MD. The Ohio State Univeristy Medical Center
Umbilical hernias are well described in the literature but the impact on health care cost, work absenteeism, and resource utilization is less well understood. Often, asymptomatic or minimally symptomatic hernias are offered watchful waiting. The long term costs to both patients and health care systems needs to be evaluated to determine optimal timing for repair. We retrospectively reviewed prospectively gathered data on over 30,000 umbilical hernia patients to analyze the over impact of surgery vs no surgery.
Methods and procedures:
The Truven database, consisting of 479 employers and 3000+ hospitals, was reviewed for all umbilical hernia patients, determined by ICD-9 codes, ages 18 to 64 who were enrolled in health plans for 12 months prior to surgery and 12 months after surgery. Patients were excluded if they had a recurrence or had been offered a “no surgery” approach within one year of the index date. Further exclusions were made for those patients missing demographics/essential information and those with outlier costs. The remaining patients (N=30,417) were separated into surgery (open or laparoscopic repair; N=15,427) or no surgery (NS) (N=14,999). The characteristics of the two groups were compared using t-test for continuous variables and chi-square test for the categorical variable. Variables included age, sex, geographic location, and Charlson Comorbidity Index. Post cost analysis at 90 and 365 was reviewed for each group as well as the estimated days off work.
Baseline characteristics were similar for the two groups aside for the presence of more females and a slightly higher comorbidity index in the NS group. Adjusted analysis showed significantly higher 90 and 365 costs for the surgery group (p <0.001), though the cost difference did decrease over time. NS group had significantly higher estimated days of health care utilization at both the 90 (1.99 vs 3.58 p <0.001) and 365 (8.69 vs 11.04 p <0.001) day post index mark.
We reviewed what we believe to be the largest umbilical hernia database to date to determine what cost nonsurgical management has for the patient and the health care system as a whole. Though the financial costs were found to be higher in the surgery group, the majority of these were due to the surgery itself. Furthermore, the difference in cost between the groups diminished considerably over time. We predict that with longer follow up, the NS group will eventually surpass the surgery group in costs. Significantly higher days of health care utilization and estimated days off work were experienced in the NS group. It is our belief that early operative intervention will lead to decreased costs and resource utilization.