Top

Hernia

Published in:

Open Access 27-06-2023 | Abdominal Surgery | Original Article

Incidence, risk factors, and burden of incisional hernia repair after abdominal surgery in France: a nationwide study

Authors: P. Ortega-Deballon, Y. Renard, J. de Launay, T. Lafon, Q. Roset, G. Passot

Published in: Hernia | Issue 4/2023

Abstract

Purpose

Incisional hernias are common after laparotomies. The aims of this study were to assess the rate of incisional hernia repair after abdominal surgery, recurrence rate, hospital costs, and risk factors, in France.

Methods

This national, retrospective, longitudinal, observational study was based on the exhaustive hospital discharge database (PMSI). All adult patients (≥ 18 years old) hospitalised for an abdominal surgical procedure between 01-01-2013 and 31-12-2014 and hospitalised for incisional hernia repair within five years were included. Descriptive analyses and cost analyses from the National Health Insurance (NHI) viewpoint (hospital care for the hernia repair) were performed. To identify risk factors for hernia repair a multivariable Cox model and a machine learning analysis were performed.

Results

In 2013–2014, 710074 patients underwent abdominal surgery, of which 32633 (4.6%) and 5117 (0.7%) had ≥ 1 and ≥ 2 incisional hernia repair(s) within five years, respectively. Mean hospital costs amounted to €4153/hernia repair, representing nearly €67.7 million/year. Some surgical sites exposed patients at high risk of incisional hernia repair: colon and rectum (hazard ratio [HR] 1.2), and other sites on the small bowel and the peritoneum (HR 1.4). Laparotomy procedure and being ≥ 40 years old put patients at high risk of incisional hernia repair even when operated on low-risk sites such as stomach, duodenum, and hepatobiliary.

Conclusion

The burden of incisional hernia repair is high and most patients are at risk either due to age ≥ 40 or the surgery site. New approaches to prevent the onset of incisional hernia are warranted.

Available only for authorised users

Gignoux B, Bayon Y, Martin D et al (2021) Incidence and risk factors for incisional hernia and recurrence: retrospective analysis of the French national database. Colorectal Dis 23:1515–1523. https://doi.org/10.1111/codi.15581CrossRefPubMed

Muysoms FE, Antoniou SA, Bury K et al (2015) European hernia society guidelines on the closure of abdominal wall incisions. Hernia 19:1–24. https://doi.org/10.1007/s10029-014-1342-5CrossRefPubMed

Dadashzadeh ER, Huckaby LV, Handzel R et al (2022) The risk of incarceration during nonoperative management of incisional hernias: a population-based analysis of 30,998 patients. Ann Surg 275:e488. https://doi.org/10.1097/SLA.0000000000003916CrossRefPubMed

Söderbäck H, Gunnarsson U, Hellman P, Sandblom G (2018) Incisional hernia after surgery for colorectal cancer: a population-based register study. Int J Colorectal Dis 33:1411–1417. https://doi.org/10.1007/s00384-018-3124-5CrossRefPubMedPubMedCentral

Höer J, Lawong G, Klinge U, Schumpelick V (2002) Factors influencing the development of incisional hernia. A retrospective study of 2983 laparotomy patients over a period of 10 years. Chir Z Alle Geb Oper Medizen 73:474–480. https://doi.org/10.1007/s00104-002-0425-5CrossRef

Le Huu NR, Mege D, Ouaïssi M et al (2012) Incidence and prevention of ventral incisional hernia. J Visc Surg 149:e3–e14. https://doi.org/10.1016/j.jviscsurg.2012.05.004CrossRef

Basta MN, Kozak GM, Broach RB et al (2019) Can we predict incisional hernia?: Development of a surgery-specific decision-support interface. Ann Surg 270:544–553. https://doi.org/10.1097/SLA.0000000000003472CrossRefPubMed

Rhemtulla IA, Hsu JY, Broach RB et al (2021) The incisional hernia epidemic: evaluation of outcomes, recurrence, and expenses using the healthcare cost and utilization project (HCUP) datasets. Hernia J Hernias Abdom Wall Surg 25:1667–1675. https://doi.org/10.1007/s10029-021-02405-9CrossRef

Bosanquet DC, Ansell J, Abdelrahman T et al (2015) Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PLoS ONE 10:e0138745. https://doi.org/10.1371/journal.pone.0138745CrossRefPubMedPubMedCentral

10.

van Ramshorst GH, Eker HH, Hop WCJ et al (2012) Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg 204:144–150. https://doi.org/10.1016/j.amjsurg.2012.01.012CrossRefPubMed

11.

Hoffman RD, Danos DM, Lau FH (2021) National health disparities in incisional hernia repair outcomes: an analysis of the healthcare cost and utilization project national inpatient sample (HCUP-NIS) 2012–2014. Surgery 169:1393–1399. https://doi.org/10.1016/j.surg.2020.11.028CrossRefPubMed

12.

Rios-Diaz AJ, Morris MP, Christopher AN et al (2022) National epidemiologic trends (2008–2018) in the United States for the incidence and expenditures associated with incisional hernia in relation to abdominal surgery. Hernia 26:1355–1368. https://doi.org/10.1007/s10029-022-02644-4CrossRefPubMed

13.

Gillion J-F, Sanders D, Miserez M, Muysoms F (2016) The economic burden of incisional ventral hernia repair: a multicentric cost analysis. Hernia 20:819–830. https://doi.org/10.1007/s10029-016-1480-zCrossRefPubMed

14.

Itatsu K, Yokoyama Y, Sugawara G et al (2014) Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg 101:1439–1447. https://doi.org/10.1002/bjs.9600CrossRefPubMed

15.

Goodenough CJ, Ko TC, Kao LS et al (2015) Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: hernia expectation rates in intra-abdominal surgery (The HERNIA Project). J Am Coll Surg 220:405. https://doi.org/10.1016/j.jamcollsurg.2014.12.027CrossRefPubMedPubMedCentral

16.

Köckerling F, Hoffmann H, Adolf D et al (2021) Potential influencing factors on the outcome in incisional hernia repair: a registry-based multivariable analysis of 22,895 patients. Hernia J Hernias Abdom Wall Surg 25:33–49. https://doi.org/10.1007/s10029-020-02184-9CrossRef

17.

Tuppin P, Rudant J, Constantinou P et al (2017) Value of a national administrative database to guide public decisions: from the système national d’information interrégimes de l’Assurance Maladie (SNIIRAM) to the système national des données de santé (SNDS) in France. Rev DÉpidémiologie Santé Publique 65:S149–S167. https://doi.org/10.1016/j.respe.2017.05.004CrossRef

18.

Agence Technique de l’Information sur l’Hospitalisation (2021) Etude Nationale des Coûts Médecine Chirurgie Obstétrique - Données 2018. In: ATIH. https://www.atih.sante.fr/enc-mco-donnees-2018. Accessed 5 Apr 2022

19.

Breiman L, Friedman JH, Olshen RA, Stone CJ (2017) Classification and regression trees. Routledge, Boca RatonCrossRef

20.

De Oliveira H, Prodel M, Augusto V (2018) Binary Classification on French Hospital Data: Benchmark of 7 Machine Learning Algorithms. In: 2018 IEEE International Conference on Systems, Man, and Cybernetics (SMC). Pp. 1743–1748

21.

Cavailles A, Melloni B, Motola S et al (2020) Identification of patient profiles with high risk of hospital re-admissions for acute COPD exacerbations (AECOPD) in France using a machine learning model. Int J Chron Obstruct Pulmon Dis 15:949–962. https://doi.org/10.2147/COPD.S236787CrossRefPubMedPubMedCentral

22.

Bouvier A-M, Launoy G, Bouvier V, et al (2020) Survie des personnes atteintes de cancer en France métropolitaine 1989–2018 - Pancréas. INCa

23.

Holihan JL, Alawadi Z, Martindale RG et al (2015) Adverse events after ventral hernia repair: the vicious cycle of complications. J Am Coll Surg 221:478–485. https://doi.org/10.1016/j.jamcollsurg.2015.04.026CrossRefPubMed

24.

Kössler-Ebs JB, Grummich K, Jensen K et al (2016) Incisional hernia rates after laparoscopic or open abdominal surgery-a systematic review and meta-analysis. World J Surg 40:2319–2330. https://doi.org/10.1007/s00268-016-3520-3CrossRefPubMed

25.

Jensen KK, Nordholm-Carstensen A, Krarup P-M, Jorgensen LN (2020) Incidence of incisional hernia repair after laparoscopic compared to open resection of colonic cancer: a nationwide analysis of 17,717 patients. World J Surg 44:1627–1636. https://doi.org/10.1007/s00268-020-05375-8CrossRefPubMed

26.

Muysoms FE, Miserez M, Berrevoet F et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia J Hernias Abdom Wall Surg 13:407–414. https://doi.org/10.1007/s10029-009-0518-xCrossRef

27.

McAuliffe PB, Desai AA, Talwar AA et al (2022) Preoperative computed tomography morphological features indicative of incisional hernia formation after abdominal surgery. Ann Surg 276:616–625. https://doi.org/10.1097/SLA.0000000000005583CrossRefPubMed

Title: Incidence, risk factors, and burden of incisional hernia repair after abdominal surgery in France: a nationwide study
Authors: P. Ortega-Deballon
Y. Renard
J. de Launay
T. Lafon
Q. Roset
G. Passot
Publication date: 27-06-2023
Publisher: Springer Paris
Keywords: Abdominal Surgery
Laparotomy
Laparotomy
Incisional Hernia
Published in: Hernia / Issue 4/2023
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-023-02825-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Incidence, risk factors, and burden of incisional hernia repair after abdominal surgery in France: a nationwide study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2023

Autoimmunity and hernia mesh: fact or fiction?

Risk factors of venous thromboembolism after incisional ventral hernia repair

Preservation of deep epigastric perforators during anterior component separation technique (ACST) results in equivalent wound complications compared to transversus abdominis release (TAR)

Comment to: Laparoscopic ventral and incisional hernia repair using intraperitoneal onlay mesh with peritoneal bridging

Microbiology of chronic mesh infection

Should routine surgical wound drainage after ventral hernia repair be avoided? A systematic review and meta-analysis