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Escobar-Domingo MJ, Hernandez Alvarez A, Merle C, Fanning JE, Lee D, Foppiani J, Kim E, Lin SJ, Lee BT. Association of Metabolic Derangement and Postoperative Outcomes in Hernia Repair With Component Separation: A Propensity Score-matched Nationwide Analysis. J Surg Res 2024; 301:136-145. [PMID: 38925100 DOI: 10.1016/j.jss.2024.05.046] [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: 11/29/2023] [Revised: 05/13/2024] [Accepted: 05/18/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Metabolic syndrome (MetS) is characterized by cardiometabolic abnormalities such as hypertension, obesity, diabetes, or dyslipidemia. This study aims to evaluate the association of MetS on the postoperative outcomes of ventral, umbilical, and epigastric hernia repair using component separation. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent ventral, umbilical, and epigastric hernia repair with component separation between 2015 and 2021. MetS status was defined as patients receiving medical treatment for diabetes mellitus and hypertension, with a body mass index greater than 30 kg/m2. Propensity matching was performed to generate two balanced cohorts with and without MetS. T-tests and Fisher's Exact tests assessed group differences. Logistic regression models evaluated complications between the groups. RESULTS After propensity score matching, 3930 patients were included in the analysis, with 1965 in each group (MetS versus non-MetS). Significant differences were observed in the severity and clinical presentation of hernias between the groups. The MetS cohort had higher rates of incarcerated hernia (39.1% versus 33.2%; P < 0.001), and recurrent ventral hernia (42.7% versus 36.5%; P < 0.001) compared to the non-MetS cohort. The MetS group demonstrated significantly increased rates of renal insufficiency (P = 0.026), unplanned intubation (P = 0.003), cardiac arrest (P = 0.005), and reoperation rates (P = 0.002) than the non-MetS cohort. Logistic regression models demonstrated higher likelihood of postoperative complications in the MetS group, including mild systemic complications (OR 1.25; 95%CI 1.030-1.518; P = 0.024), severe systemic complications (OR 1.63; 95%CI 1.248-2.120; P < 0.001), and reoperation (OR 1.47; 95%CI 1.158-1.866; P = 0.002). There were no significant differences in the rates of 30-d wound complications between groups. CONCLUSIONS The presence of metabolic derangement appears to be associated with adverse postoperative medical outcomes and increased reoperation rates after hernia repair with component separation. These findings highlight the importance of optimizing preoperative comorbidities as surgeons counsel patients with MetS.
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Affiliation(s)
- Maria J Escobar-Domingo
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Angelica Hernandez Alvarez
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Chamilka Merle
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - James E Fanning
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniela Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jose Foppiani
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Erin Kim
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Sanders DL, Pawlak MM, Simons MP, Aufenacker T, Balla A, Berger C, Berrevoet F, de Beaux AC, East B, Henriksen NA, Klugar M, Langaufová A, Miserez M, Morales-Conde S, Montgomery A, Pettersson PK, Reinpold W, Renard Y, Slezáková S, Whitehead-Clarke T, Stabilini C. Midline incisional hernia guidelines: the European Hernia Society. Br J Surg 2023; 110:1732-1768. [PMID: 37727928 PMCID: PMC10638550 DOI: 10.1093/bjs/znad284] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/08/2023] [Accepted: 08/02/2023] [Indexed: 09/21/2023]
Affiliation(s)
- David L Sanders
- Academic Department of Abdominal Wall Surgery, Royal Devon University
Foundation Healthcare Trust, North Devon District Hospital,
Barnstaple, UK
- University of Exeter Medical School,
Exeter, UK
| | - Maciej M Pawlak
- Academic Department of Abdominal Wall Surgery, Royal Devon University
Foundation Healthcare Trust, North Devon District Hospital,
Barnstaple, UK
- University of Exeter Medical School,
Exeter, UK
| | - Maarten P Simons
- Department of Surgery, OLVG Hospital Amsterdam,
Amsterdam, The
Netherlands
| | - Theo Aufenacker
- Department of Surgery, Rijnstate Hospital Arnhem,
Arnhem, The Netherlands
| | - Andrea Balla
- IRCCS San Raffaele Scientific Institute,
Milan, Italy
| | - Cigdem Berger
- Hamburg Hernia Centre, Department of Hernia and Abdominal Wall Surgery,
Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg,
Hamburg, Germany
| | - Frederik Berrevoet
- Department for General and HPB Surgery and Liver Transplantation, Ghent
University Hospital, Ghent, Belgium
| | | | - Barbora East
- 3rd Department of Surgery at 1st Medical Faculty of Charles University,
Motol University Hospital, Prague, Czech Republic
| | - Nadia A Henriksen
- Department of Gastrointestinal and Hepatic Diseases, University of
Copenhagen, Herlev Hospital, Copenhagen, Denmark
| | - Miloslav Klugar
- The Czech National Centre for Evidence-Based Healthcare and Knowledge
Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk
University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of
Medicine, Masaryk University, Brno, Czech Republic
| | - Alena Langaufová
- Department of Health Sciences, Faculty of Medicine, Masaryk
University, Brno, Czech
Republic
| | - Marc Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, KU
Leuven, Leuven, Belgium
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and
Digestive Surgery, University Hospital Virgen del Rocio, University of
Sevilla, Sevilla, Spain
| | - Agneta Montgomery
- Department of Surgery, Skåne University Hospital,
Malmö, Sweden
- Department of Clinical Sciences, Malmö Faculty of Medicine, Lund
University, Lund, Sweden
| | - Patrik K Pettersson
- Department of Surgery, Skåne University Hospital,
Malmö, Sweden
- Department of Clinical Sciences, Malmö Faculty of Medicine, Lund
University, Lund, Sweden
| | - Wolfgang Reinpold
- Hamburg Hernia Centre, Department of Hernia and Abdominal Wall Surgery,
Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg,
Hamburg, Germany
| | - Yohann Renard
- Reims Champagne-Ardennes, Department of General, Digestive and Endocrine
Surgery, Robert Debré University Hospital, Reims,
France
| | - Simona Slezáková
- The Czech National Centre for Evidence-Based Healthcare and Knowledge
Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk
University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of
Medicine, Masaryk University, Brno, Czech Republic
| | - Thomas Whitehead-Clarke
- Centre for 3D Models of Health and Disease, Division of Surgery and
Interventional Science, University College London,
London, UK
| | - Cesare Stabilini
- Department of Surgery, University of Genoa,
Genoa, Italy
- Policlinico San Martino, IRCCS, Genoa,
Italy
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Keshvedinova AA, Smirnov AV, Stankevich VR, Sharobaro VI, Ivanov YV. [Treatment of ventral hernias in patients with morbid obesity]. Khirurgiia (Mosk) 2023:95-102. [PMID: 37707338 DOI: 10.17116/hirurgia202309195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
The review is devoted to the treatment of ventral hernias in patients with morbid obesity. This issue is important due to significant number of such patients and no unambiguous clinical recommendations. The advantages of simultaneous surgery (with bariatric intervention) are obvious, i.e. lower risk of postoperative hernia incarceration and no need for re-hospitalization with another intervention. High risk of bariatric population makes it necessary to minimize surgery time and surgical trauma. A staged approach with reducing body weight surgically or conservatively before hernia repair is often chosen. Hernia repair should be performed using laparoscopic or robotic techniques with obligatory use of mesh implants. Panniculectomy or abdominoplasty as the main surgery is a valid option. Currently, it is necessary to develop clear criteria for selecting patients with morbid obesity for staged and simultaneous treatment of ventral hernias.
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Affiliation(s)
- A A Keshvedinova
- Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
| | - A V Smirnov
- Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
| | - V R Stankevich
- Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
| | - V I Sharobaro
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Yu V Ivanov
- Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Fransvea P, Costa G, Lepre L, Capolupo GT, Carannante F, Puccioni C, Costa A, La Greca A, Giovinazzo F, Sganga G. Metabolic Syndrome (MetS), Systemic Inflammatory Response Syndrome (SIRS), and Frailty: Is There any Room for Good Outcome in the Elderly Undergoing Emergency Surgery? Front Surg 2022; 9:870082. [PMID: 35784911 PMCID: PMC9240383 DOI: 10.3389/fsurg.2022.870082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/17/2022] [Indexed: 12/15/2022] Open
Abstract
Background Patients with MetS or SIRS experience higher rates of mortality and morbidity, across both cardiac and noncardiac surgery. Frailty assessment has acquired increasing importance in recent years as it predisposes elderly patients to a worse outcome. The aim of our study was to investigate the influence of MetS, SIRS, and with or without frailty on elderly patients undergoing emergency surgical procedures. Methods We analyzed data of all patients with nonmalignant diseases requiring an emergency surgical procedure from January 2017 to December 2020. The occurrence of MetS was identified using modified definition criteria used by the NCEP-ATP III Expert Panel: obesity, hypertension, diabetes, or if medication for high triglycerides or for low HDL cholesterol was taken. Systemic inflammatory response syndrome (SIRS) was evaluated according to the original consensus study (Sepsis-1). The frailty profile was investigated by the 5-modified Frailty Index (5-mFI) and the Emergency Surgery Frailty Index (EmSFI). Postoperative complications have been reported and categorized according to the Clavien-Dindo (C-D) classification system. Morbidity and mortality have been mainly considered as the 30-day standard period definition. Results Of the 2,318 patients included in this study, 1,010 (43.6%) fulfilled the criteria for MetS (MetsG group). Both 5-Items score and EmsFI showed greater fragility in patients with MetS. All patients with MetS showed more frequently a CACI index greater than 6. The occurrence of SIRS was higher in MetSG. LOS was longer in patients with MetS (MetSG 11.4 ± 12 days vs. n-MetSG 10.5 ± 10.2 days, p = 0.046). MetSG has a significantly higher rate of morbidity (353 (35.%) vs. 385 (29.4%), p = 0.005). The mortality rate in patients with MetS (98/1010, 10%) was similar to that in patients without it (129/1308, 10%). Considering patients with MetS who developed SIRS and those who had frailty or both, the occurrence of these conditions was associated with a higher rate of morbidity and mortality. Conclusion Impact of MetS and SIRS on elderly surgical patient outcomes has yet to be fully elucidated. The present study showed a 43.6% incidence of MetS in the elderly population. In conclusion, age per se should be not considered anymore as the main variable to estimate patient outcomes, while MetS and Frailty should have always a pivotal role.
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Affiliation(s)
- Pietro Fransvea
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| | - Gianluca Costa
- Surgery Center, Colorectal Surgery Unit - Fondazione Policlinico Campus Bio-Medico, University Hospital of University Campus Bio-Medico of Rome, Rome, Italy
| | - Luca Lepre
- General Surgery Unit, Santo Spirito in Sassia Hospital, Rome, Italy
| | - Gabriella Teresa Capolupo
- Surgery Center, Colorectal Surgery Unit - Fondazione Policlinico Campus Bio-Medico, University Hospital of University Campus Bio-Medico of Rome, Rome, Italy
| | - Filippo Carannante
- Surgery Center, Colorectal Surgery Unit - Fondazione Policlinico Campus Bio-Medico, University Hospital of University Campus Bio-Medico of Rome, Rome, Italy
| | - Caterina Puccioni
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Alessandro Costa
- UniCamillus School of Medicine, -Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Antonio La Greca
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Giovinazzo
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
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Dietz UA, Kudsi OY, Gokcal F, Bou-Ayash N, Pfefferkorn U, Rudofsky G, Baur J, Wiegering A. Excess Body Weight and Abdominal Hernia. Visc Med 2021; 37:246-253. [PMID: 34540939 DOI: 10.1159/000516047] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/22/2021] [Indexed: 01/09/2023] Open
Abstract
Background Obese patients have an increased incidence of ventral hernias; in over 50% of these cases, patients are symptomatic. At the same time, morbid obesity is a disease of epidemic proportions. The combination of symptomatic hernia and obesity is a challenge for the treating surgeon, because the risk of perioperative complications and recurrence increases with increasing BMI. Summary This review outlines this problem and discusses interdisciplinary approaches to the management of affected patients. In emergency cases, the hernia is treated according to the surgeon's expertise. In elective cases, an individual decision must be made whether bariatric surgery is indicated before hernia repair or whether both should be performed simultaneously. After bariatric surgery a weight reduction of 25-30% of total body weight in the first year can be achieved and it is often advantageous to perform a bariatric operation prior to hernia repair. Technically, the risk of complications is lower with minimally invasive procedures than with open ones, but laparoscopy is challenging in obese patients, and meshes can only be implanted in intraperitoneal position. This mesh position has to be questioned because of adhesions, recurrence rate, and risk of contamination during re-interventions in patients who are often still relatively young. Key Messages Obese patients with hernia need to be approached in an interdisciplinary manner, in some patients a weight loss procedure may be advantageous before hernia repair. Recent data show the benefits of robotic hernia surgery in obese patients, as not only haptic advantages result, but especially the mesh can be implanted in a variety of extraperitoneal positions in the abdominal wall with low morbidity.
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Affiliation(s)
- Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Olten, Switzerland
| | - Omar Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, Brockton, Massachusetts, USA
| | - Fahri Gokcal
- Department of Surgery, Good Samaritan Medical Center, Brockton, Massachusetts, USA
| | - Naseem Bou-Ayash
- Department of Surgery, Good Samaritan Medical Center, Brockton, Massachusetts, USA
| | - Urs Pfefferkorn
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Olten, Switzerland.,Center for Metabolic Diseases, Cantonal Hospital Olten (soH), Olten, Switzerland
| | - Gottfried Rudofsky
- Department of Surgery, Good Samaritan Medical Center, Brockton, Massachusetts, USA.,Center for Metabolic Diseases, Cantonal Hospital Olten (soH), Olten, Switzerland
| | - Johannes Baur
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Olten, Switzerland
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
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Baig SJ, Priya P. Management of ventral hernia in patients with BMI > 30 Kg/m 2: outcomes based on an institutional algorithm. Hernia 2020; 25:689-699. [PMID: 33044608 DOI: 10.1007/s10029-020-02318-z] [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: 06/25/2020] [Accepted: 09/28/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Management of ventral hernia in obese is a complex problem. The methods of weight loss, alternatives if the patient cannot undergo bariatric surgery, timing, and type of hernia surgery lacks clarity and are dependent on resources and expertise. There is a need for algorithms based on local population and expertise. In this paper, we present the outcomes of our institutional algorithm. METHODS It was a retrospective analysis of prospectively collected data. Patients with body mass index (BMI) > 30Kg/m2 were included to undergo surgery as per algorithm taking into account (a) presentation (symptomatic vs asymptomatic), (b) hernia characteristics (defect width, site, reducibility), and (c) obesity characteristics (BMI, subcutaneous fat, android vs gynecoid). Data on age, BMI, comorbidities, tobacco consumption, hernia width, location, contents, previous surgery, intraoperative parameters (the type of surgery, mesh, drain, fixation), and outcomes (seroma, hematoma, infection, recurrence) were collected. RESULTS A total of 50 patients underwent treatment as per the algorithm. Mean BMI was 36.6 ± 7.3 kg/m2. The mean follow-up was 17.6 ± 7.2 months. The mean defect width was 4.8 ± 2.9 cm. There were two (4%) recurrences in patients who underwent an anatomical repair under emergency conditions. None of the patients who underwent an elective repair had a recurrence. Total surgical site occurrence was 12% and surgical site occurrence requiring procedural intervention was 8%. There was one (2%) mortality on postoperative day 7 due to myocardial infarction. CONCLUSION The algorithm has shown encouraging results in the short-to-medium term. Long-term evaluation with a higher number of patients is needed to confirm its usefulness.
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Affiliation(s)
- S J Baig
- Belle Vue Clinic, 9 and 10, Loudon street, Kolkata, India
| | - P Priya
- Belle Vue Clinic, 9 and 10, Loudon street, Kolkata, India.
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Frailty predicts morbidity, complications, and mortality in patients undergoing complex abdominal wall reconstruction. Hernia 2019; 24:235-243. [DOI: 10.1007/s10029-019-02047-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/02/2019] [Indexed: 12/11/2022]
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Bernardi K, Martin AC, Holihan JL, Olavarria OA, Flores-Gonzalez JR, Cherla DV, Lyons NB, Shah P, Kao LS, Ko TC, Liang MK. Is non-operative management warranted in ventral hernia patients with comorbidities? A case-matched, prospective 3 year follow-up, patient-centered study. Am J Surg 2019; 218:1234-1238. [PMID: 31421893 DOI: 10.1016/j.amjsurg.2019.07.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/02/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND We hypothesized that long-term quality of life (QoL) is improved among patients with ventral hernias (VHs) and comorbid conditions managed operatively than with non-operative management. METHODS This was the 3-year follow-up to a prospective observational study of patients with comorbid conditions and VHs. Primary outcome was change in QoL measured utilizing the modified Activities Assessment Scale (AAS), a validated, hernia-specific survey. Outcomes were compared using: (1)paired t-test on matched subset and (2)multivariable linear regression on the overall cohort. RESULTS In the matched cohort (n = 80; 40/group), the operative group experienced a significantly greater improvement in QoL compared to the non-operative group (28.4 ± 27.1 vs. 11.8 ± 23.8,p = 0.005). The operative group, had 10 (25.0%) reported recurrences while the non-operative group, reported 4/15 (26.7%) recurrences among the 15 (37.5%) patients that underwent repair. On multivariable analysis of the whole cohort (n = 137), operative management was associated with a 19.5 (95% CI7.0-31.9) point greater improvement in QoL compared to non-operative management. CONCLUSIONS This is the first long term prospective study showing the benefits of operative as opposed to non-operative management of patients with comorbid conditions and VHs.
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Affiliation(s)
- Karla Bernardi
- McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX, USA; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Alexander C Martin
- McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Julie L Holihan
- McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX, USA; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Oscar A Olavarria
- McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX, USA; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Juan R Flores-Gonzalez
- McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Deepa V Cherla
- McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX, USA; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Nicole B Lyons
- McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Puja Shah
- McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Lillian S Kao
- McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX, USA; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Tien C Ko
- McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Mike K Liang
- McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX, USA; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX, USA.
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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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10
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Nia AM, Branch DW, Maynard K, Frank T, Zavlin D, Patterson JT, Lall RR. Metabolic Syndrome Associated with Increased Rates of Medical Complications After Intracranial Tumor Resection. World Neurosurg 2019; 126:e1055-e1062. [DOI: 10.1016/j.wneu.2019.03.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/20/2022]
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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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