J. R. Montgomery2,3, J. Henderson1, J. B. Dimick2,3, D. A. Telem2,3 1University Of Michigan,Statistics,Ann Arbor, MI, USA 2University Of Michigan,General Surgery,Ann Arbor, MI, USA 3University Of Michigan,Center For Healthcare Outcomes & Policy,Ann Arbor, MI, USA
Introduction: Performance of component separation (CS) as part of an open hernia repair has doubled over the past 6 years. The impact of CS as part of open hernia repair (OHR) on hernia recurrence and healthcare expenditures when compared to OHR alone remains unknown. We aim to characterize the comparative risk of hernia recurrence after CS and associated difference in overall healthcare expenditures.
Methods: Using Truven Marketscan Data, patients aged 18 to 65 who underwent an abdominal wall hernia repair from 2009 to 2015 were identified. Recurrence was defined as any hernia repair within two years of index operation. Multivariate logistic regression models and time-to-event analyses were used to determine factors associated with hernia recurrence. Healthcare expenditures were defined by total inpatient payments and both price-standardized and inflation-adjusted.
Results: A total of 22,157 patients underwent hernia repair during the study period. For those patients who completed two years of follow-up (n=7,547), CS (n=1,074) was associated with a decreased incidence of hernia recurrence when compared to OHR (n=6,473) alone for both recurrent (7.5% vs 11.8%, p=0.028) and nonrecurrent (5.2% vs 9.6%, p<0.001) hernias. In a two-factor logistic regression, CS was protective for hernia recurrence (OR 0.55, 95%CI 0.42-0.72, p<0.001), whereas recurrent hernias were more likely to recur again (OR 1.29, 95%CI 1.07-1.56, p=0.008). In a proportional hazard models using all index repairs regardless of follow-up and adjusting for baseline recurrent hernia, CS remained associated with decreased chance of subsequent hernia recurrence (HR 0.51, 95%CI 0.42-0.61, p<0.001) [Figure 1]. Compared to OHR, CS was associated with an increased initial cost of $8,406 ($24,484 vs $16,078). However, given its lower postoperative recurrence rate, it is subsequently associated with a decreased cost of $131 per year, per patient.
Conclusion: Our analysis reveals that CS as part of an OHR is associated with decreased recurrence rates at 2-years as compared to OHR alone. Although initially more expensive, its decreased postoperative recurrence rate is associated with a subsequent savings of $131 per year, per patient. Utilization of CS for patients with highest risk of postoperative hernia recurrence may result in decreased overall healthcare expenditures.
