Cost of ventral hernia repair using biologic or synthetic mesh

Crystal F. Totten, Daniel L. Davenport, Nicholas D. Ward, J. Scott Roth

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Background Patients undergoing ventral hernia repair (VHR) with biologic mesh (BioM) have higher hospital costs compared with synthetic mesh (SynM). This study compares 90-d pre- and post-VHR hospital costs (180-d) among BioM and SynM based on infection risk. Methods This retrospective National Surgical Quality Improvement Program study matched patient perioperative risk with resource utilization cost for a consecutive series of VHR repairs. Patient infection risks, clinical and financial outcomes were compared in unmatched SynM (n = 303) and BioM (n = 72) groups. Propensity scores were used to match 35 SynM and BioM pairs of cases with similar infection risk for outcomes analysis. Results BioM patients in the unmatched group were older with higher American Society of Anesthesiologists (ASA) and wound classification, and they more frequently underwent open repairs for recurrent hernias. Wound surgical site infections were more frequent in unmatched BioM patients (P = 0.001) as were 180-d costs ($43.8k versus $14.0k, P < 0.001). Propensity matching resulted in 31 clean cases. In these low-risk patients, wound occurrences and readmissions were identical, but 180-d costs remained higher ($31.8k versus $15.5k, P < 0.001). There were no differences in hospital 180-d diagnostic, emergency room, intensive care unit, floor, pharmacy, or therapeutic costs. However, 180-d operating room services and supply costs were higher in the BioM group ($21.1k versus $7.1k, P < 0.001). Conclusions BioM is used more commonly in hernia repairs involving higher wound class and ASA scores and recurrent hernias. Clinical outcomes after low-risk VHRs are similar; SynM utilization in low-risk hernia repairs was more cost-effective.

Original languageEnglish
Pages (from-to)459-465
Number of pages7
JournalJournal of Surgical Research
Volume203
Issue number2
DOIs
StatePublished - Jun 15 2016

Bibliographical note

Funding Information:
The authors acknowledge and express their gratitude for the expert work of the NSQIP nurses, Devauna Riley, RN, and Roseanna Adair, RN, along with the financial analyst, Daniel Heidemann, MBA, in generating the data used in this study, the University of Kentucky General Surgery Research program for support with IRB, and study administration as well as Margaret Plymale for editing assistance. This work was funded in part by a grant from LifeCell Corporation ( 13-0426-P3H ), makers of biologic mesh. LifeCell had no involvement in the study design; collection, analysis, or interpretation of data; in the writing of the report; or the decision to submit this article.

Keywords

  • Biologic
  • Cost
  • Hernia
  • Mesh
  • Outcomes
  • Synthetic

ASJC Scopus subject areas

  • Surgery

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