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Schlosser KA, Maloney SR, Gbozah K, Prasad T, Colavita PD, Augenstein VA, Heniford BT. The impact of weight change on intra-abdominal and hernia volumes. Surgery 2020; 167:876-882. [PMID: 32151368 DOI: 10.1016/j.surg.2020.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/05/2020] [Accepted: 01/14/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Weight loss is often encouraged or required before open ventral hernia repair. This study evaluates the impact of weight change on total, intra-abdominal, subcutaneous, and hernia volume. METHODS Patients who underwent open ventral hernia repair from 2007 to 2018 with two preoperative computed tomography scans were identified. Scans were reviewed using 3D volumetric software. Demographics, operative characteristics, and outcomes were evaluated. The impact of weight change on intra-abdominal, subcutaneous, and hernia volume was assessed using Spearman's correlation coefficients and linear regression models. RESULTS A total of 250 patients met the criteria with a mean defect area of 155.6 ± 155.4 cm2, subcutaneous volume of 6,800.0 ± 3,868.8 cm3, hernia volume of 915.7 ± 1,234.5 cm3, intra-abdominal volume equaling 4,250.2 ± 2,118.1 cm3, and time between computed tomography scans 13.9 ± 11.0 months. Weight change was associated with change in hernia, intra-abdominal, total, and subcutaneous volume (Spearman's correlation coefficients 0.17, 0.48, 0.51, 0.45, respectively, P ≤ 0.03 all values) and not associated in hernia length, width, or area (P ≥ 0.18 all values). A Δ5 kg was significantly associated with Δintra-abdominal volume (164.1 ± 30.0 cm3/Δ5 kg,P < .0001), Δtotal volume (209.9 ± 33.0 cm3/Δ5 kg, P < .0001), and Δsubcutaneous volume (234.4 ± 50.8 cm3/Δ5 kg, P < .0001). Per Δ5 kg, male patients had more than double the Δintra-abdominal, Δtotal, and Δsubcutaneous volume than did female patients. A weight change of 5 kg to10 kg was associated with approximately double the change in computed tomography parameters/Δ5 kg than any weight change after 10 kg. Regardless of weight change, all measured hernia parameters increased over time, with mean hernia volume of +40.6 ± 94.9 cm3/mo and area of +7.8 ± 13.3 cm2/mo (Spearman's correlation coefficient -0.03 to 0.07, P value 0.37-0.96). CONCLUSION Weight change is linearly correlated with intra-abdominal and subcutaneous fat gain or loss. Males show greater abdominal-related response to weight gain or loss. Hernia dimensions increase over time regardless of weight change.
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Affiliation(s)
- Kathryn A Schlosser
- Department of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Sean R Maloney
- Department of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Korene Gbozah
- Department of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Tanushree Prasad
- Department of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Paul D Colavita
- Department of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Vedra A Augenstein
- Department of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - B Todd Heniford
- Department of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC.
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Schlosser KA, Maloney SR, Horton JM, Prasad T, Colavita PD, Heniford BT, Augenstein VA. The association of penicillin allergy with outcomes after open ventral hernia repair. Surg Endosc 2020; 34:4148-4156. [PMID: 32016513 DOI: 10.1007/s00464-019-07183-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/30/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Up to 11% of patients report a penicillin allergy (PA), with 1-2% demonstrating a true IgE mediated allergy upon testing. PA patients often receive non-beta-lactam antibiotic surgical prophylaxis (non-BLP). This study evaluates the relationship of PA to outcomes after open ventral hernia repair (OVHR). METHODS A prospective institutional database was queried for patients undergoing OVHR. Demographics, operative characteristics, and outcomes were evaluated by the reported PA and the administration of beta-lactam prophylaxis (BLP). RESULTS Allergy histories were reviewed in 1178 patients. PA was reported in 21.6% of patients, with 55.5% reporting rash or hives, 15.0% airway compromise or anaphylaxis, and 29.5% no specific reaction. BLP was administered to 76.3% of patients, including 22.1% of PA patients and 89.9% of patients without PA. PA patients were more often female (64.6% PA patients vs. 56% non-PA, p = 0.01), with higher rates of chronic steroids, MRSA, anxiety, asthma, COPD, chronic pain, and sleep apnea (p < 0.03 all values). PA patients had higher rates of contaminated cases, including mesh infection and fistula. Of the 683 clean cases, 82.1% received BLP. Of the 117 clean contaminated cases (CDC wound class 2), 82.9% received BLP, which was associated with reduced long-term readmission for hernia complications (21.5 vs. 55%, p = 0.002, OR 0.27, CI 0.09-0.83). In the 120 CDC wound class 3 and 4 patients, 65.8% received BLP. In multivariate analysis, BLP was associated with lower rates of reoperation (OR 0.31, CI 0.12-0.76) and recurrence (OR 0.32, CI 0.11-0.86). BLP was given to 22.1% of the PA patients with no adverse reactions noted. CONCLUSION PA patients had more comorbidities and complex ventral hernias. When controlling for contamination and MRSA history, BLP is associated with improved outcomes particularly in contaminated cases. PA may be a risk factor for patient complexity, and further studies are warranted to determine if allergy testing can be warranted in known or anticipated contaminated cases.
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Affiliation(s)
- Kathryn A Schlosser
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Sean R Maloney
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - James M Horton
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Tanushree Prasad
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Paul D Colavita
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA. .,Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
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Improving Shared Decision-making and Treatment Planning Through Predictive Modeling: Clinical Insights on Ventral Hernia Repair. Comput Inform Nurs 2020; 38:227-231. [PMID: 31929356 DOI: 10.1097/cin.0000000000000590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abdominal wall hernia repair, including ventral hernia repair, is one of the most common general surgical procedures. Nationally, at least 350 000 ventral hernia repairs are performed annually, and of those, 150 000 cases were identified as incisional hernias. Outcomes are reported to be poor, resulting in additional surgical repair rates of 12.3% at 5 years and as high as 23% at 10 years. Healthcare costs associated with ventral hernia repair are estimated to exceed $3 billion each year. Additionally, ventral hernia repair is often complex and unpredictable when there is a current infection or a history of infection and significant comorbidities. Accordingly, a predictive model was developed using a retrospectively collected dataset to associate the pre- and intra-operative characteristics of patients to their outcomes, with the primary goal of identifying patients at risk of developing complications a priori in the future. The benefits and implications of such a predictive model, however, extend beyond this primary goal. This predictive model can serve as an important tool for clinicians who may use it to support their clinical intuition and clarify patient need for lifestyle modification prior to abdominal wall reconstruction. This predictive model can also support shared decision-making so that a personalized plan of care may be developed. The outcomes associated with use of the predictive model may include surgical repair but may suggest lifestyle modification coupled with less invasive interventions.
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Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Simons MP. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg 2020; 107:171-190. [PMID: 31916607 DOI: 10.1002/bjs.11489] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/31/2019] [Accepted: 12/02/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias. METHODS The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019. RESULTS Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large, or if the patient has an increased risk of wound morbidity. CONCLUSION This is the first European and American guideline on the treatment of umbilical and epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired by an open approach with a preperitoneal flat mesh.
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Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - R Kaufmann
- Erasmus University Medical Centre, Rotterdam, the Netherlands.,Tergooi, Hilversum, the Netherlands
| | - F Berrevoet
- Department of General and Hepatopancreatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - B East
- Third Department of Surgery at Motol University Hospital, First and Second Faculty of Medicine at Charles University, Prague, Czech Republic
| | - J Fischer
- University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - W Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - D Klassen
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Lorenz
- Praxis 3+ Chirurgen, Berlin, Germany
| | - Y Renard
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - M A Garcia Urena
- Henares University Hospital, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands
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Mesh fistula after ventral hernia repair: What is the optimal management? Surgery 2019; 167:590-597. [PMID: 31883631 DOI: 10.1016/j.surg.2019.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 09/03/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND A mesh-related intestinal fistula is an uncommon and challenging complication of ventral hernia repair. Optimal management is unclear owing to lack of prospective or long-term data. METHODS We reviewed our prospective data for mesh-related intestinal fistulas from 2004 to 2017and compared suture repair versus ventral hernia repair with mesh at the time of mesh-related intestinal fistula takedown. RESULTS Eighty-two mesh-related intestinal fistulas were treated; none of the fistulas had closed spontaneously, and all fistula persisted at the time of our treatment. Mean age was 61 ± 12 years with 33-month follow-up. Comorbidities were similar between groups. Defects were 2.5-times larger in ventral hernia repair with mesh (324 ± 392 cm2 vs 1301 ± 133 cm2; P = .044). Components separation (64% vs 21%; P = .0003) and panniculectomy (35% vs 7%; P = .0074) were more common in ventral hernia repair with mesh. Mortality occurred in 4 patients. Complications were similar. In patients undergoing ventral hernia repair with non-bridged, acellular, porcine dermal matrix, hernia recurrence was less than in patients without mesh (26% vs 66%; P = .0030). Only partial excision of the mesh involved with the fistula resulted in a substantial increase in developing another fistula (29% vs 6%; P < .05). CONCLUSION Patients undergoing preperitoneal ventral hernia repair with mesh for mesh-related intestinal fistula had a lesser rate of hernia recurrence and similar complications compared to suture repair despite larger hernias. Complete mesh excision decreases the risk of fistula recurrence. We maintain that ventral hernia repair with mesh during mesh-related intestinal fistula takedown represents the best opportunity for a durable herniorrhaphy.
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Plymale MA, Davenport DL, Walsh-Blackmore S, Hess J, Griffiths WS, Plymale MC, Totten CF, Roth JS. Costs and Complications Associated with Infected Mesh for Ventral Hernia Repair. Surg Infect (Larchmt) 2019; 21:344-349. [PMID: 31816266 DOI: 10.1089/sur.2019.183] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Mesh hernia repair is widely accepted because of the associated reduction in hernia recurrence compared with suture-based repair. Despite initiatives to reduce risk, mesh infection and mesh removal are a significant challenge. In an era of healthcare value, it is essential to understand the global cost of care, including the incidence and cost of complications. The purpose of this study was to identify the outcomes and costs of care of patients who required the removal of infected hernia mesh. Methods: A review of databases from 2006 through June 2018 identified patients who underwent both ventral hernia repair (VHR) and re-operation for infected mesh removal. Patient demographic and operative details for both procedures, including age, Body Mass Index, mesh type, amount of time between procedures, and information regarding interval procedures were obtained. Clinical outcome measures were the length of the hospital stay, hospital re-admission, incision/non-incision complications, and re-operation. Hospital cost data were obtained from the cost accounting system and were combined with the clinical data for a cost and clinical representation of the cases. Results: Thirty-four patients underwent both VHR and removal of infected mesh material over the 12-year time frame and were included in the analyses; the average age at VHR was 48 years, and 16 patients (47%) were female. Following VHR, 21 patients (62%) experienced incision complications within 90 days post-operatively, the complications ranging from superficial surgical site infection (SSI) to evisceration. A mean of 22.65 months passed between procedures. After mesh removal, 16 patients (47%) experienced further incisional complications; and 22 (65%) patients had at least one re-admission. Eighteen patients (53%) required a minimum of one additional related operative procedure after mesh removal. Median hospital costs nearly doubled (p < 0.001) for the mesh removal ($23,841 [interquartile range {IQR} $13,596-$42,148]) compared with the VHR admission ($13,394 [IQR $8,424-$22,161]) not accounting for re-admission costs. A majority experienced hernia recurrence subsequent to mesh removal. Conclusions: Mesh infection after hernia repair is associated with significant morbidity and costs. Hospital re-admission, re-operations, and recurrences are common among these patients, resulting in greater healthcare resource utilization. Development of strategies to prevent mesh infection, identify patients most likely to experience infectious complications, and define best practices for the care of patients with mesh infection are needed.
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Affiliation(s)
- Margaret A Plymale
- Division of General Surgery, University of Kentucky, Lexington, Kentucky, USA
| | | | | | - Jordan Hess
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | | | - Mary C Plymale
- Division of General Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Crystal F Totten
- Division of General Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - John Scott Roth
- Division of General Surgery, University of Kentucky, Lexington, Kentucky, USA
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Jensen KK, Arnesen RB, Christensen JK, Bisgaard T, Jørgensen LN. Large Incisional Hernias Increase in Size. J Surg Res 2019; 244:160-165. [DOI: 10.1016/j.jss.2019.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/25/2019] [Accepted: 06/06/2019] [Indexed: 12/12/2022]
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When the Mesh Goes Away: An Analysis of Poly-4-Hydroxybutyrate Mesh for Complex Hernia Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2576. [PMID: 31942324 PMCID: PMC6908335 DOI: 10.1097/gox.0000000000002576] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/18/2019] [Indexed: 12/16/2022]
Abstract
Mesh reinforcement is a cornerstone of modern ventral hernia repair (VHR); yet, complications with synthetic mesh and cost of biologic have created a need for alternative options. Biosynthetic mesh is a resorbable scaffold that theoretically leverages the benefits and minimizes deficiencies of existing mesh types. This study evaluates 2-year outcomes following poly-4-hydroxybutyrate (P4HB) mesh reinforcement for complex VHR. Methods A retrospective review of all consecutive VHR with P4HB (n = 70) was conducted from 2015 to 2018 by a single surgeon. Clinical outcomes, quality of life (QoL; and cost were assessed. Results Seventy patients were included with an average age and body mass index of 58.6 years and 33 kg/m2, respectively. High-risk comorbidities included hypertension (59%), and smoking history (50%). Cases were primarily modified Ventral Hernia Working Group class 2 (50%), or 3 (36%), with average defect size of 323 cm2 (25-972 cm2). P4HB was placed in the retromuscular (80%) or onlay (20%) plane. Mean follow-up was 24 months (12.2-41 months). Hernia recurrence rate was 5.7% (n = 4) and occurred an average of 285 days (209-368 days) post-repair. Of the 21 surgical site occurrences (SSO), 5 (7%) required surgical intervention. A significant improvement in overall QoL (P = 0.001) was noted following repair. Defect size and SSOPI were independently associated with increased direct cost. Conclusions P4HB mesh for complex VHR is associated with favorable 2-year clinical outcomes, acceptable hernia recurrence rate, and a significant improvement in QoL. This study supports the use of biosynthetic mesh as an effective biomaterial for complex VHR.
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Howard R, Thompson M, Fan Z, Englesbe M, Dimick JB, Telem DA. Costs Associated With Modifiable Risk Factors in Ventral and Incisional Hernia Repair. JAMA Netw Open 2019; 2:e1916330. [PMID: 31774525 PMCID: PMC6902835 DOI: 10.1001/jamanetworkopen.2019.16330] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Ventral and incisional hernia repair (VIHR) is an extremely common operation, after which complications are also fairly common. A number of preoperative risk factors are known to contribute to increased complications after surgical repair; however, the individual relative association of these risk factors with adverse outcomes and increased spending is unclear. Quantifying the association of individual risk factors may help surgeons implement targeted surgical optimization, improve outcomes, and reduce spending. OBJECTIVE To identify the attributable association of modifiable risk factors for adverse outcomes after VIHR on outcomes and episode-of-care payments. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was performed using a population-based sample of adult patients and episode spending data from January 1, 2012, to December 31, 2018, from a statewide multipayer registry. A multilevel mixed-effects logistic regression model was used to examine the contribution of patient-specific risk factors to adverse outcomes. Attributable risk and population attributable risk fraction were calculated to estimate the additional spending attributable to individual risk factors. Data were analyzed from April 2018 to September 2018. MAIN OUTCOMES AND MEASURES Any complications, serious complication, discharge not to home, 30-day emergency department utilization, and 30-day readmission. Episode-of-care spending was calculated for these outcomes. RESULTS This study included 22 664 patients (median [interquartile range] age, 55 [44-64] years; 10 496 [46.3%] women) undergoing VIHR with identified significant preoperative risk factors. Fourth-quartile body mass index (BMI), calculated as weight in kilograms divided by height in meters squared and defined as a mean (SD) BMI of 43 (6), was associated with increased risk of any complication (odds ratio [OR], 1.64; 95% CI, 1.30-2.06; P < .001) and serious complication (OR, 1.67; 95% CI, 1.22-2.31; P = .002). Insulin-dependent diabetes was associated with increased risk of any complication (OR, 1.34; 95% CI, 1.03-1.73; P = .03), serious complication (OR, 1.51; 95% CI, 1.08-2.12; P = .02), discharge not to home (OR, 1.49; 95% CI, 1.12-1.98; P = .005), and 30-day readmission (OR, 1.68; 95% CI, 1.32-2.14; P < .001). Median (interquartile range) additional episode spending for any complication was $9934 ($9224-$11 851), of which $1304 ($1208-$1552) was attributable to fourth-quartile BMI. Median (interquartile range) additional episode spending for a serious complication was $26 648 ($20 632-$33 166), of which $3638 ($2827-$4544) was attributable to fourth-quartile BMI, $650 ($495-$796) was attributable to insulin-dependent diabetes, and $567 ($433-$696) was attributable to unhealthy alcohol use. CONCLUSIONS AND RELEVANCE In this cross-sectional study, modifiable risk factors, such as obesity, insulin-dependent diabetes, and unhealthy alcohol use, were associated with adverse outcomes after VIHR. These factors were significantly associated with increased health care spending; therefore, preoperative optimization may improve outcomes and decrease episode-of-care costs.
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Affiliation(s)
- Ryan Howard
- Department of Surgery, University of Michigan Health System, Ann Arbor
| | - Michael Thompson
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor
- Michigan Value Collaborative, Ann Arbor
- Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Zhaohui Fan
- Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Michael Englesbe
- Department of Surgery, University of Michigan Health System, Ann Arbor
| | - Justin B. Dimick
- Department of Surgery, University of Michigan Health System, Ann Arbor
- Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Dana A. Telem
- Department of Surgery, University of Michigan Health System, Ann Arbor
- Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
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Prevalence of posttraumatic stress disorder (PTSD) in patients with an incisional hernia. Am J Surg 2019; 218:934-939. [DOI: 10.1016/j.amjsurg.2019.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/25/2019] [Accepted: 03/02/2019] [Indexed: 12/19/2022]
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Maloney SR, Augenstein VA, Oma E, Schlosser KA, Prasad T, Kercher KW, Sing RF, Colavita PD, Heniford BT. The use of component separation during abdominal wall reconstruction in contaminated fields: A case-control analysis. Am J Surg 2019; 218:1096-1101. [PMID: 31630827 DOI: 10.1016/j.amjsurg.2019.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Component separation technique (CST) allows fascial medialization during abdominal wall reconstruction (AWR). Wound contamination increases the incidence of wound complications, which multiplies the incidence of repair failure. The aim of this study was to compare the impact of CST on AWR outcomes in contaminated fields in comparison to those operations without CST. METHODS A prospective, single institution hernia database was queried for patients undergoing AWR with CST and contamination. A case control cohort was identified using propensity score matching. RESULTS There were 286 CSTs performed in contaminated cases. After propensity score matching, 61 CSTs were compared to 61 No-CSTs. These groups were matched by defect area (CST:287.1 ± 150.4 vs No-CST:277.6 ± 218.4 cm2, p = 0.156), BMI (32.0 ± 7.0 vs 32.2 ± 6.0 kg/m2, p = 0.767), diabetes (26.2% vs 32.8%, p = 0.427), and panniculectomy (52.5% vs 36.1%, p = 0.068). Groups had similar rates of wound complications (42.6% vs 40.7%, p = 0.829) and recurrence (4.9% vs 13.1%, p = 0.114). CONCLUSIONS The use of CST in the face of contamination is not associated with an increase in wound complications, mesh complications, or recurrence.
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Affiliation(s)
- Sean R Maloney
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | | | - Erling Oma
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Tanushree Prasad
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Kent W Kercher
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Ronald F Sing
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Paul D Colavita
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - B Todd Heniford
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
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Maloney SR, Schlosser KA, Prasad T, Kasten KR, Gersin KS, Colavita PD, Kercher KW, Augenstein VA, Heniford BT. Twelve years of component separation technique in abdominal wall reconstruction. Surgery 2019; 166:435-444. [DOI: 10.1016/j.surg.2019.05.043] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
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Nisiewicz MJ, Plymale MA, Davenport DL, Saleh S, Buckley TD, Hassan ZU, Roth JS. Validation and Extension of the Ventral Hernia Repair Cost Prediction Model. J Surg Res 2019; 244:153-159. [PMID: 31288184 DOI: 10.1016/j.jss.2019.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/30/2019] [Accepted: 06/06/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Repair of ventral and incisional hernias remains a costly challenge for health care systems. In a previous study of a single surgeon's elective open ventral hernia repair (VHR) practice, a cost model was developed, which predicted over 70% of hospital cost variation. The purpose of the present study was to evaluate the ventral hernia cost model with multiple surgeons' elective open VHR cases and extending to include nonelective and laparoscopic VHR. MATERIALS AND METHODS With the University of Kentucky Institutional Review Board approval, elective and emergent cases of open and laparoscopic VHR performed by multiple surgeons over 3 y were identified. Perioperative variables were obtained from the local American College of Surgeons National Surgery Quality Improvement Program database and electronic medical record review. Hospital cost data were obtained from the hospital cost accounting system. Forward multivariable regression of log-transformed costs identified independent cost drivers (P for entry < 0.05, and P for exit > 0.10). RESULTS Of the 387 VHRs, 74% were open repairs; mean age was 55 y, and 52% of patients were female. For open, elective cases (n = 211; mean cost of $19,145), the previously reported six-factor cost model predicted 45% of the total cost variation. With all VHRs included, additional variables were found to independently drive costs, predicting 59% of the total cost variation from the base cost. The biggest cost drivers were inpatient status (+$1013), use of biologic mesh (+$1131), preoperative systemic inflammatory response syndrome/sepsis (+$894), and preoperative open wound (+$786). CONCLUSIONS Ventral hernia repair cost variability is predictable. Understanding the independent drivers of cost may be helpful in controlling costs and in negotiating appropriate reimbursement with payers.
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Affiliation(s)
| | - Margaret A Plymale
- Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | | | - Sherif Saleh
- University of Kentucky College of Medicine, Lexington, Kentucky
| | - Tori D Buckley
- University of Kentucky College of Medicine, Lexington, Kentucky
| | - Zain U Hassan
- University of Kentucky College of Medicine, Lexington, Kentucky
| | - John Scott Roth
- Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky.
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Alkhatib H, Tastaldi L, Krpata DM, Petro CC, Huang LC, Phillips S, Fafaj A, Rosenblatt S, Rosen MJ, Prabhu AS. Impact of modifiable comorbidities on 30-day wound morbidity after open incisional hernia repair. Surgery 2019; 166:94-101. [DOI: 10.1016/j.surg.2019.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/01/2019] [Accepted: 03/11/2019] [Indexed: 01/15/2023]
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Three-dimensional hernia analysis: the impact of size on surgical outcomes. Surg Endosc 2019; 34:1795-1801. [PMID: 31236720 DOI: 10.1007/s00464-019-06931-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/12/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION BMI and hernia defect size are strongly associated with outcomes after open ventral hernia repair (OVHR). The impact of abdominal subcutaneous fat (SQV), intra-abdominal volume (IAV), hernia volume (HV), and ratio of HV to intra-abdominal volume (HV:IAV, representing visceral eventration) is less clearly elucidated. This study examines the interaction of multiple markers of adiposity and hernia size in OVHR. METHODS OVHR with preoperative CT scans were identified. 3D volumetric software measured HV, SQV, IAV, and HV:IAV was calculated. A principal component analysis was performed to create new component variables for collinear variables. Hernia PC was composed primarily of hernia dimensions, EAV (extra-abdominal volume PC) included SQV and BMI, and IAV PC included IAV. RESULTS A total of 1178 OVHR patients had a preoperative CT scan. Their demographics included a mean age of 58.5 ± 12.4 years, BMI of 34.2 ± 7.7 kg/m2, and 57.8% were female. The mean defect area was 150.8 ± 136.7 cm2, and 66.0% were recurrent, Patients had mean SQV of 6719.4 ± 3563.9 cm3, HV of 966.9 ± 1303.5 cm3, IAV of 4250.2 ± 2118.1 cm3, and a HV:IAV of 0.29 ± 0.46. In multivariate analysis, Hernia PC was associated with panniculectomy (OR 1.52, CI 1.37-1.69) and component separation (OR 1.34, CI 1.21-1.49) and was negatively associated with fascial closure (OR 0.78, CI 0.69-0.88). Hernia PC was also associated with reoperation, readmission, and development of wound complications (OR 1.18, CI 1.08-1.30; OR 1.15, CI 1.04-1.27; OR 1.28, CI 1.16-1.41, respectively). EAV PC was associated with performance of a panniculectomy (OR 1.33, CI 1.20-1.48), readmission (OR 1.18, CI 1.06-1.32), and wound complications (OR 1.41, CI 1.27-1.57). IAV PC was not associated with adverse outcomes. CONCLUSION Values of hernia area, volume, IAV, HV:IAV, BMI, and SQV are collinear markers of patient obesity and hernia proportions. They are distinct enough to be represented by three principal component variables, indicating more nuanced discrete influences on variability of surgical outcomes other than BMI.
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Kao AM, Arnold MR, Otero J, Huang LC, Prasad T, Lincourt AE, Augenstein VA. Comparison of Outcomes After Partial Versus Complete Mesh Excision. Ann Surg 2019; 272:177-182. [PMID: 30672793 DOI: 10.1097/sla.0000000000003198] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Evaluate outcomes of patients undergoing mesh explantation following partial mesh excision (PME) and complete mesh excision (CME). BACKGROUND Ventral hernia repair (VHR) with mesh remains one of the most commonly performed procedures worldwide. Management of previously placed mesh during reexploration remains unclear. Studies describing PME as a feasible alternative have been limited. METHODS The AHSQC registry was queried for VHR patients who underwent mesh excision. Variables used for propensity-matching included age, BMI, race, diabetes, COPD, OR time>2 hours, immunosuppressants, smoking, active infection, ASA class, elective case, wound classification, and history of abdominal wall infection. RESULTS A total of 1904 VHR patients underwent excision of prior mesh. After propensity matching, complications were significantly higher (35% vs 29%, P = 0.01) after PME, including SSI/SSO, SSOPI, and reoperation. No differences were observed in patients with clean wounds, however in clean-contaminated, PME more frequently resulted in SSOPI (24% vs 9%, P = 0.02). In mesh infection/fistulas, higher rates of SSOPI (46% vs 24%, P = 0.04) and reoperation (21% vs 6%, P = 0.03) were seen after PME. Odds-ratio analysis showed increased likelihood of SSOPI (OR 1.5, 95% CI 1.05-2.14; P = 0.023) and reoperation (OR 2.2, 95% CI 1.13-4.10; P = 0.015) with PME. CONCLUSIONS With over 350,000 VHR performed annually and increasing mesh use, guidelines for management of mesh during reexploration are needed. This analysis of a multicenter hernia database demonstrates significantly increased postoperative complications in PME patients with clean-contaminated wounds and mesh infections/fistulas, however showed similar outcomes in those with clean wounds.
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Affiliation(s)
- Angela M Kao
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Michael R Arnold
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Javier Otero
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Tanushree Prasad
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Amy E Lincourt
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
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Cost-Utility Analysis of Biologic and Biosynthetic Mesh in Ventral Hernia Repair: When Are They Worth It? J Am Coll Surg 2019; 228:66-71. [DOI: 10.1016/j.jamcollsurg.2018.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/22/2022]
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MELD-Na score associated with postoperative complications in hernia repair in non-cirrhotic patients. Hernia 2018; 23:51-59. [DOI: 10.1007/s10029-018-1849-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/29/2018] [Indexed: 11/25/2022]
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Mesh Versus Patch Repair for Epigastric and Umbilical Hernia (MORPHEUS Trial); One-Year Results of a Randomized Controlled Trial. World J Surg 2018; 42:1312-1320. [PMID: 29026977 DOI: 10.1007/s00268-017-4297-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
DESIGN This trial is a randomized controlled, patient-blinded, multicentre, superiority trial. METHODS All patients ≥18 years with a single, symptomatic and primary umbilical or epigastric hernia (<2 fingers) qualified for participation in the study. Flat polypropylene mesh repair was compared to patch repair (PROCEED® Ventral Patch) (PVP). The objective of this trial was to identify a superior method for umbilical and epigastric hernia repair in terms of complication rates. RESULTS A total of 352 patients were randomized in this trial; 348 patients received the intervention (n = 177 PVP vs. n = 171 mesh). No peri-operative complications occurred. PVP placement was significantly faster compared to mesh placement (30 min, SD 11 vs. 35 min, SD 11) and was scored as an easier procedure. At 1-month follow-up, 76 patients suffered any kind of complication. There was no significant difference in the proportion of complications (24.9% for PVP and 18.7% for mesh, p = 0.195). A significant difference was seen in re-operation rate within 1 month, significantly less early re-operations in the mesh group (0.0 vs. 2.8%, p = 0.027). After 1-year follow-up, no significant differences are seen in recurrence rates (n = 13, 7.8% PVP vs. n = 5, 3.3% mesh, p = 0.08). CONCLUSIONS Both mesh and PVP had a comparable amount of reported complications. There was a significantly higher incidence of early re-operations due to early complications in the PVP group. No differences were seen in infection rates and the need for antibiotic treatment. No significant difference was seen in the recurrence rates. REGISTRATION This trial was registered in the Dutch Trail Registry (NTR) NTR2514NL33995.060.10. [12].
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Building a Multidisciplinary Hospital-Based Abdominal Wall Reconstruction Program. Plast Reconstr Surg 2018; 142:201S-208S. [DOI: 10.1097/prs.0000000000004879] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Prevention and Treatment Strategies for Mesh Infection in Abdominal Wall Reconstruction. Plast Reconstr Surg 2018; 142:149S-155S. [DOI: 10.1097/prs.0000000000004871] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Davenport DL, Hughes TG, Mirembo RI, Plymale MA, Roth JS. Professional fee payments by specialty for inpatient open ventral hernia repair: who gets paid for treating comorbidities and complications? Surg Endosc 2018; 33:494-498. [PMID: 29987571 DOI: 10.1007/s00464-018-6323-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to determine perioperative professional fee payments to providers from different specialties for the care of patients undergoing inpatient open ventral hernia repair (VHR). METHODS Perioperative data of patients undergoing VHR at a single center over 3 years were selected from our NSQIP database. 180-day follow-up data were obtained via retrospective review of records and phone calls to patients. Professional fee payments (PFPs) to all providers were obtained from our physician billing system for the VHR hospitalization, the 180 days prior to operation (180Prior) and the 180 days post-discharge (180Post). RESULTS PFPs for 283 cases were analyzed. Average total 360-day PFPs per patient were $3409 ± SD 3294, with 14.5% ($493 ± 1546) for services in the 180Preop period, 72.5% ($2473 ± 1881) for the VHR hospitalization, and 13.0% ($443 ± 1097) in the 180Postop period. The surgical service received 62% of PFPs followed by anesthesia (18%), medical specialties (9%), radiology (6%), and all other provider services (5%). Medical specialties received increased PFPs for care of patients with COPD and HCT < 38% ($90 and $521, respectively) and for the pulmonary complications ($2471) and sepsis ($2714) that correlated with those patient comorbidities; surgeons did not. Operative duration, mesh size, and separation of components were associated with increased surgeon PFPs (p < .05). At 6 months, wound complications were associated with increased surgeon and radiology payments (p < .01). CONCLUSIONS Management of acute comorbid conditions and the associated higher postoperative morbidity is not reimbursed to the surgeon under the 90-day global fee. These represent opportunity costs of care that pressure busy surgeons to select against these patients or to delegate more management to their medical specialty colleagues, thereby increasing total system costs. A comorbid risk adjustment of procedural reimbursement is warranted. In negotiating bundled payments, surgeon groups should keep in mind that surgeon reimbursement, unlike medical specialty and hospital reimbursement, have been bundled since the 1990s.
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Affiliation(s)
- Daniel L Davenport
- Department of Surgery, University of Kentucky, 800 Rose Street, Room MN274, Lexington, KY, 40536-0298, USA.
| | - Travis G Hughes
- Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Ray I Mirembo
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Margaret A Plymale
- Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - J Scott Roth
- Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
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Abstract
This article reviews the literature that supports routine expectations for smoking cessation; weight loss; diabetic, nutritional, or metabolic optimization; and decolonization techniques before ventral hernia repair. These methods diminish postoperative complications. In an era of value-centric care, an upfront investment in patient optimization can improve the quality of the repair by reducing wound morbidity and hernia recurrence, naturally translating to a reduction in cost. The adoption of these practices and further study aimed at identifying other effective optimization techniques are encouraged.
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Affiliation(s)
- Clayton C Petro
- Department of Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Ajita S Prabhu
- Department of Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Chattha A, Bucknor A, Chi D, Ultee K, Chen AD, Lin SJ. Drivers of Hospital Costs in the Self-Pay Facelift (Rhytidectomy) Patient: Analysis of Hospital Resource Utilization in 1890 Patients. Aesthetic Plast Surg 2018; 42:603-609. [PMID: 29101441 DOI: 10.1007/s00266-017-0984-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Rhytidectomy is one of the most commonly performed cosmetic procedures by plastic surgeons. Increasing attention to the development of a high-value, low-cost healthcare system is a priority in the USA. This study aims to analyze specific patient and hospital factors affecting the cost of this procedure. METHODS We conducted a retrospective cohort study of self-pay patients over the age of 18 who underwent rhytidectomy using the Healthcare Utilization Cost Project National Inpatient Sample database between 2013 and 2014. Mean marginal cost increases patient characteristics, and outcomes were studied. Generalized linear modeling with gamma regression and a log-link function were performed along with estimated marginal means to provide cost estimates. RESULTS A total of 1890 self-pay patients underwent rhytidectomy. Median cost was $11,767 with an interquartile range of $8907 [$6976-$15,883]. The largest marginal cost increases were associated with postoperative hematoma ($12,651; CI $8181-$17,120), West coast region ($7539; 95% CI $6412-$8666), and combined rhinoplasty ($7824; 95% CI $3808-$11,840). The two risk factors associated with the generation of highest marginal inpatient costs were smoking ($4147; 95% CI $2804-$5490) and diabetes mellitus ($5622; 95% CI $3233-8011). High-volume hospitals had a decreased cost of - $1331 (95% CI - $2032 to - $631). CONCLUSION Cost variation for inpatient rhytidectomy procedures is dependent on preoperative risk factors (diabetes and smoking), postoperative complications (hematoma), and regional trends (West region). Rhytidectomy surgery is highly centralized and increasing hospital volume significantly decreases costs. Clinicians and hospitals can use this information to discuss the drivers of cost in patients undergoing rhytidectomy. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Anmol Chattha
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - Alexandra Bucknor
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - David Chi
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - Klaas Ultee
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Austin D Chen
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA.
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Saleh S, Plymale MA, Davenport DL, Roth JS. Risk-Assessment Score and Patient Optimization as Cost Predictors for Ventral Hernia Repair. J Am Coll Surg 2018; 226:540-546. [DOI: 10.1016/j.jamcollsurg.2017.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
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Haskins IN, Horne CM, Krpata DM, Prabhu AS, Tastaldi L, Perez AJ, Rosenblatt S, Poulose BK, Rosen MJ. A call for standardization of wound events reporting following ventral hernia repair. Hernia 2018; 22:729-736. [PMID: 29429064 DOI: 10.1007/s10029-018-1748-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/25/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Postoperative wound events following ventral hernia repair are an important outcome measure. While efforts have been made by hernia surgeons to identify and address risk factors for postoperative wound events following VHR, the definition of these events lacks standardization. Therefore, the purpose of our study was to detail the variability of wound event definitions in recent ventral hernia literature and to propose standardized definitions for postoperative wound events following VHR. METHODS The top 50 cited ventral hernia, peer-reviewed publications from 1995 through 2015 were identified using the search engine Google Scholar. The definition of wound event used and the incidence of postoperative wound events was recorded for each article. The number of articles that used a standardized definition for surgical site infection (SSI), surgical site occurrence (SSO), or surgical site occurrence requiring procedural intervention (SSOPI) was also identified. RESULTS Of the 50 papers evaluated, only nine (18%) used a standardized definition for SSI, SSO, or SSOPI. The papers that used standardized definitions had a smaller variability in the incidence of wound events when compared to one another and their reported rates were more consistent with recently published ventral hernia repair literature. CONCLUSION Postoperative wound events following VHR are intimately associated with patient quality of life and long-term hernia repair durability. Standardization of the definition of postoperative wound events to include SSI, SSO, and SSOPI following VHR will improve the ability of hernia surgeons to make evidence-based decisions regarding the management of ventral hernias.
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Affiliation(s)
- I N Haskins
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA. .,Department of General Surgery, Cleveland Clinic Comprehensive Hernia Center, The Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA.
| | - C M Horne
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D M Krpata
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - A S Prabhu
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - L Tastaldi
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Arielle J Perez
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - S Rosenblatt
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - B K Poulose
- Department of Surgery, The Vanderbilt Hernia Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M J Rosen
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
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Alizai PH, Andert A, Lelaona E, Neumann UP, Klink CD, Jansen M. Impact of obesity on postoperative complications after laparoscopic and open incisional hernia repair – A prospective cohort study. Int J Surg 2017; 48:220-224. [DOI: 10.1016/j.ijsu.2017.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/27/2017] [Accepted: 11/09/2017] [Indexed: 01/28/2023]
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Roth JS, Anthone GJ, Selzer DJ, Poulose BK, Bittner JG, Hope WW, Dunn RM, Martindale RG, Goldblatt MI, Earle DB, Romanelli JR, Mancini GJ, Greenberg JA, Linn JG, Parra-Davila E, Sandler BJ, Deeken CR, Voeller GR. Prospective evaluation of poly-4-hydroxybutyrate mesh in CDC class I/high-risk ventral and incisional hernia repair: 18-month follow-up. Surg Endosc 2017; 32:1929-1936. [DOI: 10.1007/s00464-017-5886-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 09/13/2017] [Indexed: 01/30/2023]
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