Cost-effectiveness of primary abdominal wall hernia repair in a 364-bed provincial hospital of Spain

The feasibility and safety of ventral hernia repairs under local anaesthesia: a systematic review

BACKGROUND

Ventral hernias represent a significant global healthcare burden. Repair under local anaesthesia (LA) provides benefits to patients, hospitals and economies. While inguinal hernia repair under LA has been established, this has not translated to other abdominal wall hernias. This systematic review evaluates the feasibility, safety, and efficacy of performing these repairs under LA.

METHODS

A systematic review was conducted using OVID® EMBASE and MEDLINE to review articles published between 1966 and 2023. Thirty-three papers were included examining variables such as type of hernia, complications, cost-effectiveness, LA used and length of stay. All papers were quality assessed using the ROBINS-I tool. Papers assessing inguinal hernias were excluded.

RESULTS

13,491 patients underwent ventral hernia repair under LA. Complication rates for LA repairs are low, with wound infections and hematomas ranging from 0.3 to 2%. Recurrence rates were also low (0.3-2.5%). Early mobilisation and same-day discharge were notable benefits, with over 97% of patients ambulatory within hours. Postoperative pain was minimal, contributing to high patient satisfaction rates (90-97%). LA repairs proved especially beneficial for high-risk groups, including elderly and frail patients. However, these findings were only seen in hernia defects less than 5 cm. Heterogeneity among study populations, small sample sizes, and lack of standardisation in LA administration were noted.

CONCLUSION

This review supports the broader implementation of LA for ventral hernia repairs in small defects (< 5 cm), demonstrating its safety, feasibility, and patient acceptability. Careful patient selection for standardisation of best practices for LA hernia repairs offers the potential for significant cost-savings with overall favourable outcomes.

Satisfaction and perceived quality of life results in patients operated on for primary hernia of the abdominal wall

INTRODUCTION

Outpatient surgery is currently the standard procedure in 60-70% of the most prevalent surgical procedures. Minimally invasive models in health care have improved basic aspects such as postoperative pain and hospital stay, but there are few publications related to perceived quality shown by patients, such as the need for informal care at home or delay before surgery. The aim of the study was to determine the global satisfaction perceived by patients undergoing abdominal wall hernia repair.

METHODS

An ad hoc split questionnaire has been completed on satisfaction after a week and postoperative quality a month after intervention by 203 patients operated on for abdominal hernia in a year. Variables included postoperative pain, need for informal care, surgical delay, information supplied, professional management and overall satisfaction.

RESULTS

A total of 48.28% of patients needed informal care at home. They were largely attended by women, wives or daughters, for a few days. In 45.81% they were discharged on the same day, and 53.2% in less than 72 h. Overall satisfaction in the program of day surgery and short hospital stay was 94.6%.

CONCLUSIONS

The overall process of satisfaction was not related to age, sex or educational level of patients, while there was an inverse relationship between satisfaction and days of hospitalization and days of pain that required analgesia at home.

Cost-benefit analysis comparing laparoscopic and open ventral hernia repair

OBJECTIVE

Laparoscopic surgery is a successful treatment option offering significant advantages to patients compared with open ventral hernia repair. A cost-benefit analysis was performed to compare the clinical results and economic costs of the open and laparoscopic techniques for anterior abdominal wall hernia repair, in order to determine the more efficient procedure.

MATERIAL AND METHODS

We performed a prospective study of 140 patients with primary and incisional hernia, and analyzed clinical data, morbidity, costs of surgery and hospital stay costs.

RESULTS

The cost of disposable surgical supplies was higher with laparoscopic repair but reduced the average length of stay (P<.001) and patient morbidity (P<.001). The total cost of the laparoscopic procedure was, therefore, less than initially estimated, yielding a savings of 1,260€ per patient (2,865€ vs. 4,125€).

CONCLUSIONS

Laparoscopic ventral hernia repair is associated with a reduced complication rate, a lower average length of stay and with lower total costs. Laparoscopic repair can save 1.260€ for each patient, and so this procedure should be considered a cost-effective approach.

Economics of abdominal wall reconstruction

The economic aspects of abdominal wall reconstruction are frequently overlooked, although understandings of the financial implications are essential in providing cost-efficient health care. Ventral hernia repairs are frequently performed surgical procedures with significant economic ramifications for employers, insurers, providers, and patients because of the volume of procedures, complication rates, the significant rate of recurrence, and escalating costs. Because biological mesh materials add significant expense to the costs of treating complex abdominal wall hernias, the role of such costly materials needs to be better defined to ensure the most cost-efficient and effective treatments for ventral abdominal wall hernias.

[Study of accessibility costs and satisfaction comparing a MAS unit incorporated in a Hospital versus a theoretical model in a peripheral centre]

INTRODUCTION

Geographical barriers are a determining factor in the accessibility of Hospital health care, and structural changes to improve geographic accessibility must be introduced. The purpose of this study is to compare accessibility costs and the level of satisfaction obtained in an adapted Specialist Centre with a peripheral MAS (Major Ambulatory Surgery) Unit, with an already existing one incorporated into the Virgen de la Luz Hospital (Cuenca, Spain) to obtain quality health care in the sub-population nearest the peripheral Centre.

MATERIAL AND METHODS

A study was made on a comparison of the costs attributable to accessibility of 133 patients operated on due to hernia disorders in 2008 in the Cuenca Hospital of Castille-La Mancha Health Service (SESCAM), and who lived in its health area. These were compared using a simulation study for an ambulatory surgical Centre, functionally operational, but with no Major Ambulatory Surgery activity nearest to this patient population. The opinions of the patients and the increased cost-effectiveness for each alternative proposal were studied.

RESULTS

The accessibility cost, taking into account the theoretical use of the Ambulatory Centre would be 208,028.09 € and the real costs of the Hospital were 209,088.94 €, with a minimum difference between the two of 1,060.85 €, assuming similar clinical results.

CONCLUSIONS

Although there are no significant differences in accessibility costs by using an ambulatory surgery Centre compared to the Hospital, a special assessment of the use of the former is important, expressed in the satisfaction of the patients.