R. Howard1, A. Hallway1, S. O’Neill1, C. Mullens1, L. Schoel1, M. Rubyan1, D. Telem1, A. Ehlers1 1University of Michigan, Department Of Surgery, Ann Arbor, MICHIGAN, USA
Introduction: There is growing evidence that for clean ventral hernia repairs, biologic mesh has inferior outcomes compared to synthetic mesh. Moreover, it is considerably more expensive. Despite this, biologic mesh continues to be used in these cases. In an effort to inform quality improvement efforts and motivate evidence-based practice, we performed the following study to estimate the potential cost savings of reducing biologic mesh use in these cases.
Methods: We conducted a retrospective cohort study using a statewide clinical registry to identify adults who underwent clean, elective, outpatient (i.e., same-day discharge) ventral hernia repair between 1/1/21-12/31/23. The main exposure was mesh type, which was classified as biologic (including biosynthetic) and synthetic. The main outcome was mesh cost, which was obtained from our hospital’s standard charges database, or, if not available, from a standard medical supplier directory. Descriptive analysis was performed to characterize differences in mesh price, and regression was performed to asses this price discrepancy even after adjusting for differences in patient characteristics between the two groups.
Results: A total of 7,887 patients underwent elective, outpatient, clean ventral hernia repair with mesh. Mean age was 54.3 (13.8) years, 2,936 (37.2%) patients were female, and mean hernia width was 2.95 (2.23) cm. Synthetic mesh was used in 7,238 (91.8%) cases and biologic mesh was used in 649 (8.2%) cases. There were no significant differences in ASA classification or rates of smoking, diabetes, and chronic immunosuppression between the two groups. The cost of biologic mesh was 536% higher than the cost of synthetic mesh ($7,253.97 [range $1,547.99 – $59,710.80] vs. $1,139.82 [range $93.00 – $2,467.38]). Even after performing multivariable linear regression to adjust for potential differences between patients in whom biologic and synthetic mesh were used, the cost of biologic mesh was still significantly higher than synthetic mesh ($7,163.20 [95% CI $6,439-$7,887.10] vs. $1,141.58 [95% CI $1,122.59-$1,160.57]). The total cost of biologic mesh in this cohort was $4.7 million. For the 649 patients in whom biologic mesh was used, we estimated that $3.9 million would have been saved if synthetic mesh had been used instead.
Conclusion: Although infrequent, the use of biologic mesh in clean, elective, outpatient ventral hernia repair represents a significant source of unnecessary spending in current practice. Insofar as all available evidence suggests that synthetic mesh is safe and appropriate in these cases, efforts to reduce biologic mesh use in these cases could achieve significant cost savings without negatively impacting patients.