Current national practice patterns for inpatient management of ventral abdominal wall hernia in the United States

Luke M. Funk, Kyle A. Perry, Vimal K. Narula, Dean J. Mikami, W. Scott Melvin

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background The health-care burden related to ventral hernia management is substantial, with more than 3 billion dollars in expenditures annually in the US. Previous studies have suggested that the utilization of laparoscopic repair remains relatively low although national volume estimates have not been reported. We sought to estimate the inpatient national volume of elective ventral hernia surgery and characterize the proportion of laparoscopic versus open operations. Methods We analyzed data from the Nationwide Inpatient Sample to identify adults with a diagnosis of an umbilical, incisional, or ventral hernia who underwent an elective inpatient repair between 2009 and 2010. Cases that involved other major abdominal or pelvic operations were excluded. Covariates included patient demographics, surgical approach, and use of mesh. National surgical volume estimates were generated and length of stay and total hospital charges were compared for laparoscopic versus open repairs. Results A total of 112, 070 ventral hernia repairs were included in the analysis: 72.1 %(n = 80, 793)were incisional hernia repairs, while umbilical hernia repairs comprised only 6.9 %(n = 7, 788). Laparoscopy was utilized in 26.6 %(n = 29, 870) of cases.Meshwas placed in 85.8 %(n = 96, 265) of cases, including 49.3 % (n = 3, 841) of umbilical hernia repairs and 90.1 % (n = 72, 973) of incisional hernia repairs. Length of stay and total hospital charges were significantly lower for laparoscopic umbilical, incisional, and other ventral hernia repairs (p values all≤0.001). Total hospital charges during this 2-year period approached 4 billion dollars ($746 million for laparoscopic repair; $3 billion for open repair). Conclusions Utilization of laparoscopy for elective abdominal wall hernia repair remains relatively low in the US despite its excellent outcomes. Given the substantial financial burden associated with these hernias, future research focused on preventing the development and optimizing the surgical treatment of ventral abdominal wall hernias is warranted.

Original languageEnglish (US)
Pages (from-to)4104-4112
Number of pages9
JournalSurgical Endoscopy and Other Interventional Techniques
Volume27
Issue number11
DOIs
StatePublished - Nov 2013
Externally publishedYes

Fingerprint

Abdominal Hernia
Ventral Hernia
Herniorrhaphy
Abdominal Wall
Inpatients
Hospital Charges
Umbilical Hernia
Laparoscopy
Length of Stay
Umbilicus
Hernia
Health Expenditures
Demography
Delivery of Health Care

Keywords

  • Abdominal wall hernia
  • Laparoscopic ventral hernia repair
  • Minimally invasive surgery
  • National surgical trends
  • Nationwide inpatient sample

ASJC Scopus subject areas

  • Surgery

Cite this

Current national practice patterns for inpatient management of ventral abdominal wall hernia in the United States. / Funk, Luke M.; Perry, Kyle A.; Narula, Vimal K.; Mikami, Dean J.; Melvin, W. Scott.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 27, No. 11, 11.2013, p. 4104-4112.

Research output: Contribution to journalArticle

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abstract = "Background The health-care burden related to ventral hernia management is substantial, with more than 3 billion dollars in expenditures annually in the US. Previous studies have suggested that the utilization of laparoscopic repair remains relatively low although national volume estimates have not been reported. We sought to estimate the inpatient national volume of elective ventral hernia surgery and characterize the proportion of laparoscopic versus open operations. Methods We analyzed data from the Nationwide Inpatient Sample to identify adults with a diagnosis of an umbilical, incisional, or ventral hernia who underwent an elective inpatient repair between 2009 and 2010. Cases that involved other major abdominal or pelvic operations were excluded. Covariates included patient demographics, surgical approach, and use of mesh. National surgical volume estimates were generated and length of stay and total hospital charges were compared for laparoscopic versus open repairs. Results A total of 112, 070 ventral hernia repairs were included in the analysis: 72.1 {\%}(n = 80, 793)were incisional hernia repairs, while umbilical hernia repairs comprised only 6.9 {\%}(n = 7, 788). Laparoscopy was utilized in 26.6 {\%}(n = 29, 870) of cases.Meshwas placed in 85.8 {\%}(n = 96, 265) of cases, including 49.3 {\%} (n = 3, 841) of umbilical hernia repairs and 90.1 {\%} (n = 72, 973) of incisional hernia repairs. Length of stay and total hospital charges were significantly lower for laparoscopic umbilical, incisional, and other ventral hernia repairs (p values all≤0.001). Total hospital charges during this 2-year period approached 4 billion dollars ($746 million for laparoscopic repair; $3 billion for open repair). Conclusions Utilization of laparoscopy for elective abdominal wall hernia repair remains relatively low in the US despite its excellent outcomes. Given the substantial financial burden associated with these hernias, future research focused on preventing the development and optimizing the surgical treatment of ventral abdominal wall hernias is warranted.",
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AU - Perry, Kyle A.

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AU - Melvin, W. Scott

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N2 - Background The health-care burden related to ventral hernia management is substantial, with more than 3 billion dollars in expenditures annually in the US. Previous studies have suggested that the utilization of laparoscopic repair remains relatively low although national volume estimates have not been reported. We sought to estimate the inpatient national volume of elective ventral hernia surgery and characterize the proportion of laparoscopic versus open operations. Methods We analyzed data from the Nationwide Inpatient Sample to identify adults with a diagnosis of an umbilical, incisional, or ventral hernia who underwent an elective inpatient repair between 2009 and 2010. Cases that involved other major abdominal or pelvic operations were excluded. Covariates included patient demographics, surgical approach, and use of mesh. National surgical volume estimates were generated and length of stay and total hospital charges were compared for laparoscopic versus open repairs. Results A total of 112, 070 ventral hernia repairs were included in the analysis: 72.1 %(n = 80, 793)were incisional hernia repairs, while umbilical hernia repairs comprised only 6.9 %(n = 7, 788). Laparoscopy was utilized in 26.6 %(n = 29, 870) of cases.Meshwas placed in 85.8 %(n = 96, 265) of cases, including 49.3 % (n = 3, 841) of umbilical hernia repairs and 90.1 % (n = 72, 973) of incisional hernia repairs. Length of stay and total hospital charges were significantly lower for laparoscopic umbilical, incisional, and other ventral hernia repairs (p values all≤0.001). Total hospital charges during this 2-year period approached 4 billion dollars ($746 million for laparoscopic repair; $3 billion for open repair). Conclusions Utilization of laparoscopy for elective abdominal wall hernia repair remains relatively low in the US despite its excellent outcomes. Given the substantial financial burden associated with these hernias, future research focused on preventing the development and optimizing the surgical treatment of ventral abdominal wall hernias is warranted.

AB - Background The health-care burden related to ventral hernia management is substantial, with more than 3 billion dollars in expenditures annually in the US. Previous studies have suggested that the utilization of laparoscopic repair remains relatively low although national volume estimates have not been reported. We sought to estimate the inpatient national volume of elective ventral hernia surgery and characterize the proportion of laparoscopic versus open operations. Methods We analyzed data from the Nationwide Inpatient Sample to identify adults with a diagnosis of an umbilical, incisional, or ventral hernia who underwent an elective inpatient repair between 2009 and 2010. Cases that involved other major abdominal or pelvic operations were excluded. Covariates included patient demographics, surgical approach, and use of mesh. National surgical volume estimates were generated and length of stay and total hospital charges were compared for laparoscopic versus open repairs. Results A total of 112, 070 ventral hernia repairs were included in the analysis: 72.1 %(n = 80, 793)were incisional hernia repairs, while umbilical hernia repairs comprised only 6.9 %(n = 7, 788). Laparoscopy was utilized in 26.6 %(n = 29, 870) of cases.Meshwas placed in 85.8 %(n = 96, 265) of cases, including 49.3 % (n = 3, 841) of umbilical hernia repairs and 90.1 % (n = 72, 973) of incisional hernia repairs. Length of stay and total hospital charges were significantly lower for laparoscopic umbilical, incisional, and other ventral hernia repairs (p values all≤0.001). Total hospital charges during this 2-year period approached 4 billion dollars ($746 million for laparoscopic repair; $3 billion for open repair). Conclusions Utilization of laparoscopy for elective abdominal wall hernia repair remains relatively low in the US despite its excellent outcomes. Given the substantial financial burden associated with these hernias, future research focused on preventing the development and optimizing the surgical treatment of ventral abdominal wall hernias is warranted.

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KW - National surgical trends

KW - Nationwide inpatient sample

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