Validation and Extension of the Ventral Hernia Repair Cost Prediction Model

Michael J. Nisiewicz, Margaret A. Plymale, Daniel L. Davenport, Sherif Saleh, Tori D. Buckley, Zain U. Hassan, John Scott Roth

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Repair of ventral and incisional hernias remains a costly challenge for health care systems. In a previous study of a single surgeon's elective open ventral hernia repair (VHR) practice, a cost model was developed, which predicted over 70% of hospital cost variation. The purpose of the present study was to evaluate the ventral hernia cost model with multiple surgeons' elective open VHR cases and extending to include nonelective and laparoscopic VHR. Materials and methods: With the University of Kentucky Institutional Review Board approval, elective and emergent cases of open and laparoscopic VHR performed by multiple surgeons over 3 y were identified. Perioperative variables were obtained from the local American College of Surgeons National Surgery Quality Improvement Program database and electronic medical record review. Hospital cost data were obtained from the hospital cost accounting system. Forward multivariable regression of log-transformed costs identified independent cost drivers (P for entry < 0.05, and P for exit > 0.10). Results: Of the 387 VHRs, 74% were open repairs; mean age was 55 y, and 52% of patients were female. For open, elective cases (n = 211; mean cost of $19,145), the previously reported six-factor cost model predicted 45% of the total cost variation. With all VHRs included, additional variables were found to independently drive costs, predicting 59% of the total cost variation from the base cost. The biggest cost drivers were inpatient status (+$1013), use of biologic mesh (+$1131), preoperative systemic inflammatory response syndrome/sepsis (+$894), and preoperative open wound (+$786). Conclusions: Ventral hernia repair cost variability is predictable. Understanding the independent drivers of cost may be helpful in controlling costs and in negotiating appropriate reimbursement with payers.

Original languageEnglish
Pages (from-to)153-159
Number of pages7
JournalJournal of Surgical Research
StatePublished - Dec 2019

Bibliographical note

Funding Information:
J.S.R. has grant funding from Bard and Miromatrix; he is a consultant for Bard, Johnson & Johnson, and Allergan, and he owns stock in Miromatrix. The other authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Publisher Copyright:
© 2019 Elsevier Inc.


  • Cost drivers
  • Cost model
  • Cost prediction
  • Inpatient status
  • Mesh utilization
  • Ventral hernia repair

ASJC Scopus subject areas

  • Surgery


Dive into the research topics of 'Validation and Extension of the Ventral Hernia Repair Cost Prediction Model'. Together they form a unique fingerprint.

Cite this