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Surgical Endoscopy

Published in:

01-03-2016

Laparoscopic versus open ventral hernia repair: longitudinal outcomes and cost analysis using statewide claims data

Authors: Brett L. Ecker, Lindsay E. Y. Kuo, Kristina D. Simmons, John P. Fischer, Jon B. Morris, Rachel R. Kelz

Published in: Surgical Endoscopy | Issue 3/2016

Abstract

Background

There is still considerable debate regarding the best operative approach to ventral hernia repair. Using two large statewide databases, this study sought to evaluate the longitudinal outcomes and associated costs of laparoscopic and open ventral hernia repair.

Methods

All patients undergoing elective ventral hernia repair from 2007–2011 were identified from inpatient discharge data from California and New York. In-hospital morbidity, in-hospital mortality, incidence of readmission, and incidence of revisional ventral hernia repair were evaluated as a function of surgical technique. The associated costs of medical care for laparoscopic versus open ventral hernia repair were evaluate for both the index procedure and all subsequent admissions and procedures within the study period.

Results

A total of 13,567 patients underwent elective ventral hernia repair with mesh; 9228 (69 %) underwent OVHR and 4339 (31 %) underwent LVHR. At time of the index procedure, LVHR was associated with a lower incidence of reoperation (OR 0.29, CI 0.12–0.58, p = 0.001), wound disruption (OR 0.35, CI 0.16–0.78, p = 0.01), wound infection (OR 0.50, CI 0.25–0.70, p < 0.001), blood transfusion (OR 0.47, CI 0.36–0.61, p < 0.001), ARDS (OR 0.74, CI 0.54–0.99, p < 0.05), and total index visit complications (OR 0.72, CI 0.64–0.80, p < 0.001). LVHR was associated with significantly fewer readmissions (OR 0.81, CI 0.75–0.88, p < 0.001) and a lower risk for revisional VHR (OR 0.75, CI 0.64–0.88, p < 0.001). LVHR was associated with lower total costs at 1 year ($3451, CI 1892–5011, p < 0.001).

Conclusions

Open ventral hernia repair was associated with a higher incidence of perioperative complications, postoperative readmissions and need for revisional hernia repair when compared to laparoscopic ventral hernia repair, even when controlling for patient sociodemographics. In congruence, open ventral hernia repair was associated with higher costs for both the index hernia repair and tallied over the length of follow-up for readmissions and revisional hernia repair.

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Title: Laparoscopic versus open ventral hernia repair: longitudinal outcomes and cost analysis using statewide claims data
Authors: Brett L. Ecker
Lindsay E. Y. Kuo
Kristina D. Simmons
John P. Fischer
Jon B. Morris
Rachel R. Kelz
Publication date: 01-03-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 3/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4310-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Laparoscopic versus open ventral hernia repair: longitudinal outcomes and cost analysis using statewide claims data

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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