Validation and Extension of the Ventral Hernia Repair Cost Prediction Model

A comparison of clinical outcomes and costs between robotic and open ventral hernia repair

BACKGROUND

As robotic ventral hernia repair(VHR) adoption increases, real-world evidence is needed to ensure appropriate utilization.

METHODS

Data for open and robotic VHR(OVHR, RVHR) was retrospectively analyzed. Outcomes and costs were compared via inverse probability treatment weighting using propensity scores to estimate the average treatment effect on the treated for RVHR.

RESULTS

675 open and 609 robotic ventral hernia repairs were included. Demographics and hernia characteristics were comparable. Complications rates were lower in RVHR(p < 0.001). Clavien-Dindo grade-III complications were lower in RVHR(13.2% vs. 4.9%, p < 0.001). RVHR resulted in fewer surgical site events(21.5% vs. 12.2%, p < 0.001). Recurrence rates were greater in OVHR(8.9% vs. 2.8%, p < 0.001). The higher RVHR hospital costs (Δ = $2456, p = 0.005) were balanced by the lower post-discharge costs, compared to OVHR(Δ = $799, p = 0.023). Total costs did not differ(Δ = $1656 p = 0.081).

CONCLUSION

Although hospital costs were higher, post-discharge expenses favored RVHR due to the lower postoperative complications, which lead to comparable total costs to OVHR.

Variability drivers of treatment costs in hospitals: A systematic review

OBJECTIVES

Studies on variability drivers of treatment costs in hospitals can provide the necessary information for policymakers and healthcare providers seeking to redesign reimbursement schemes and improve the outcomes-over-cost ratio, respectively. This systematic literature review, focusing on the hospital perspective, provides an overview of studies focusing on variability in treatment cost, an outline of their study characteristics and cost drivers, and suggestions on future research methodology.

METHODS

We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Handbook for Systematic Reviews of Interventions. We searched PubMED/MEDLINE, Web of Science, EMBASE, Scopus, CINAHL, Science direct, OvidSP and Cochrane library. Two investigators extracted and appraised data for citation until October 2020.

RESULTS

90 eligible articles were included. Patient, treatment and disease characteristics and, to a lesser extent, outcome and institutional characteristics were identified as significant variables explaining cost variability. In one-third of the studies, the costing method was classified as unclear due to the limited explanation provided by the authors.

CONCLUSION

Various patient, treatment and disease characteristics were identified to explain hospital cost variability. The limited transparency on how hospital costs are defined is a remarkable observation for studies wherein cost variability is the main focus. Recommendations relating to variables, costs, and statistical methods to consider when designing and conducting cost variability studies were provided.

Ventral hernia patient outcomes postoperatively housed on surgical vs non-surgical units

BACKGROUND

Inpatient hospital units vary in staffing ratios, monitoring, procedural abilities, and experience with unique patients and diagnoses. The purpose of this study is to assess the impact of patient cohorting upon ventral hernia repair outcomes.

METHODS

An IRB-approved retrospective review of open ventral hernia repairs between August 2013 and July 2017 was performed. The information of all patient locations during hospitalization, time at location, post-anesthesia care unit duration (PACU), and intensive care unit (ICU) duration was collected. Patient demographics, comorbidities, operative details, cost, and patient outcomes were analyzed. Multivariable analysis of log length of stay (LOS) was assessed with adjustment for clinical and operative factors.

RESULTS

235 patients underwent open ventral hernia repair. 179 patients were admitted to surgical units, 33 non-surgical units, and 23 stayed on both units. Clinical characteristics including patient age, gender, BMI, and medical comorbidities were similar between patients boarded on surgical versus non-surgical units. Hernia, wound, and operative data were also statistically similar. Patients admitted to non-surgical units for any duration experienced longer hospital stay (4 vs. 6 days, p < 0.001). Patients housed on a non-surgical unit were more likely to transfer rooms than patients on surgical units, 42.9% vs. 10.1% (p < 0.001), respectively. Multivariable analysis of natural log-transformed LOS showed any stay on a non-surgical unit increased LOS by 1.0 days (95% Cl 0.9-1.2 days, p = 0.026). There were no differences in ICU or PACU stay, cost, or postoperative complications in patients housed on surgical versus non-surgical units.

CONCLUSIONS

Postoperative surgical patients had an increased length of stay when admitted to non-surgical units. More frequent room transfers occurred in patients admitted to non-surgical units. Evaluation of patient outcomes and LOS in open ventral hernia repair patients based on hospital unit is unique to this study.

Preoperative opioid use and incidence of surgical site infection after repair of ventral and incisional hernias

BACKGROUND

Preoperative opioid use is a risk factor for complications after some surgical procedures. The purpose of this study was to investigate the influence of preoperative opiates on outcomes after ventral hernia repair.

METHODS

With institutional review board approval, we conducted a retrospective review of consecutive ventral hernia repair cases during a 4-y period.

RESULTS

A striking 48% of the total 234 patients met criteria for preoperative opioid use. Preoperative characteristics and operative details were similar between patient groups (preoperative opioid use versus no preoperative opioid use). Median duration of hospital stay trended toward an increase for opioid users versus nonopioid users (P = .06). Return of bowel function was delayed in opioid users compared with nonopioid users (P = .018). Incidence of superficial surgical site infection was increased among patients who used opioids preoperatively (27% vs 8.3%; P <.001) and remained so after multivariable logistic regression, (adjusted odds ratio 2.9, 95% confidence interval 1.2-6.7; P = .013).

CONCLUSION

Among patients undergoing ventral hernia repair, those with preoperative opioid use experienced an increased incidence of superficial surgical site infection compared with patients without preoperative opioid use. Further study is needed to understand the relationship between opioid use and surgical site infection after ventral hernia repair.