M. J. Carney1, J. P. Fox1, J. M. Weissler1, J. P. Fischer1 1University Of Pennsylvania,Division Of Plastic Surgery,Philadelphia, PA, USA
Introduction: There are between 4 to 5 million laparotomies performed annually in the United States (US) despite a distinct trend towards minimally invasive surgery. Laparoscopic surgical approaches have resulted in decreased length of stay, with no changes in short term complications, while still possessing similar oncologic outcomes to more traditional open surgery. Up to 30% of patients undergoing laparotomy will develop incisional hernia (IH), amounting a cost burden of $3.2 billion annually. Despite the paradigm shifts towards minimally invasive techniques, persistent hernia morbidity poses an equivocal disconnect warranting critical review. We aim to address these trends through analysis of the largest all-payer inpatient care database.
Methods: Using the 2009-2013 Nationwide Inpatient Sample, we conducted a cross-sectional review of hospital discharges of open abdominal surgery. For each event the database offered diagnostic and procedural coding (i.e., ICD-9-CM and CPT-4), as well as other socio-demographic and clinical variables. We sub-grouped the resultant discharges into the following categories: endocrine, vascular, hematologic and lymphatic, esophagus and stomach, intestine (small and large), hepatobiliary and pancreas, hernia, urology, other abdominal, gynecology, obstetrics, and transplant. To assess comorbidities, enhanced-Elixhauser algorithm was used.
Results: Between 2009 and 2013, there were nearly 10 million discharges associated with an open abdominal surgery based on our collection of ICD-9 procedural code identifiers. Overall, there were 2,140,616 patients receiving open surgery in 2009, decreasing to 1,760,549 in 2013 (0.82% change, p<0.001). Each subgroup demonstrated a congruent decrease in open procedures except for hernia. These procedures increased from 37,325 patients in 2009 to 41,845 in 2013 (1.12% change, p=0.001). The most prevalent comorbidities within this population included uncomplicated hypertension (25.26%), chronic pulmonary diseases (13.52%), obesity (10.24%), uncomplicated diabetes (11.06%), and depression (10.72%).
Conclusion: Our large volume analysis allowed for a unique view of surgical trends, health care population dynamics, and an opportunity to use evidence-driven analytics in the understanding of IH. Previous studies have primarily focused on categorizing IH repair techniques, occurrence risk factors, and recurrence within a specific surgical field. Public health initiatives in a preventative model are paramount and encourage health care providers to implement best practice techniques at point of care.
