T. C. Cox1, L. J. Blair1, C. R. Huntington1, P. D. Colavita1, A. E. Lincourt1, B. T. Heniford1, V. A. Augenstein1 1Carolinas Medical Center,Division Of Gastrointestinal And Minimally Invasive Surgery,Charlotte, NC, USA
Introduction: Many patients with complex ventral hernias have comorbidities. This study compared patients with PCm to those patients without such risks to evaluate the financial impact of PCm during elective surgery.
Methods: In this prospective study of OVHR at a single institution from 2007-2011, total hospital costs and outcomes for patients with PCm—diabetes, tobacco use, and obesity—were compared to patients without such risks. Outcomes included total wound complications, wound infections, and mesh infections. Cost evaluation included all hernia-related visits, interventions, or readmissions within one year.
Results: The 249 OVHR patients were categorized into four groups: No PCm without complications(n=85), No PCm with complications(n=33), two or more PCm without complications(n=50), and two or more PCm with complications(n=81). The majority were female(55.8%); mean age was 56.6 years, average defect size 202.01cm2. BMI of the PCm group with complications was 40kg/m2 compared to 36kg/m2 in the PCm without complications(p<0.05). There was no difference in BMI in the no PCm groups(p>0.05). For all patients with wound complications, total hospital costs were $80,660 with PCm compared to $55,444 in those without PCm (p<0.05). There was no difference in hospital costs in those with PCm without complications compared to no PCm with complications($65,453 vs$55,444, p>0.05). Even when no complications occurred, patients with PCm had higher costs than those without PCm for inpatient($61,269 vs$31,236, p<0.05), outpatient($4,185 vs$552, p<0.05), and total hospital costs($65,453 vs$31,788, p≤0.001). PCm vs no PCm did not impact number of office visits comparing the groups without complications(2.18 vs2.54, p>0.05) or those with complications(5.15 vs5.89, p>0.05). For all patients with wound complications, readmission in the PCm group was 37% compared to 21% in the no PCm group.
Conclusion: OVHR patients with PCm have higher hospital costs than those without PCm even when no complications occurred. Furthermore, patients with PCm and no complications showed no difference in total hospital costs than those with no PCm that had complications. Aggressive risk reduction can translate into saving tens of thousands of dollars in hospital care costs. Novel tactics for preoperative optimization of patients prior to elective surgery are indicated.
