VALUE ASSESMENT FOR EPIGASTRIC AND UMBILICAL HERNIA REPAIR AT A HEALTH SYSTEM NETWORK OVER AN 11 YEARS PERIOD.
Araceli D. Cuaranta*, Michael Abdelmasseh, Arslan Iqbal, Errington C. Thompson, Robert Finley, Barbara Payne, Cierra King, Grace Montgomery, Jonathan Willis, Vineela Kadiyala, Juan Sanabria
Marshall University Joan C Edwards School of Medicine, Huntington, WV
BACKGROUND. Over a million hernia repair (HR) procedures are performed annually in the US, with 10-15% of them being umbilical and epigastric hernia repairs. When compared to inguinal hernias, epigastric and umbilical HR have a higher recurrence rate, consequently healthcare providers and payers have suggested new strategies to connect reimbursement to performance. We aim to determine the value of umbilical/epigastric hernia repair as a service line in our Health System Network.
METHODS. Clinical variables (v=81) from patients (> 18 years old) were retrieved from a Health System Warehouse retrospectively (Jan-2010 to July-2016), and prospectively (Aug- 2016 to Dec-2020), under IRB-approved protocols. Quality domains (Observed/Expected) assessed on post-operative complications (PC were standardized by a grading system), length of stay (LOS in days), 30-day readmission (RA), net promoter score as surrogate for patient satisfaction (PS), and textbook cases (TB). Total charges (TC) and reimbursement index (RI, O/E) were included as surrogates for cost. Patient follow ups complemented with e-mail surveys were used to determine recurrence rates. Modeling for Uni/multivariate analyses were conducted by SPSS and MATLAB r2020b.
RESULTS. From the patients that underwent umbilical and epigastric hernia repairs (n=1637), 62% were performed as open procedures (OP) and 38% as minimal invasive (MI), with a gender distribution ratio of 3:2 for males, at a mean age & BMI of 52±14years and 34±8kg/m2, respectively. While OP and MI revealed similar value, the placement of mesh in either approach (OP=76.3%, and MI=64.7%) showed a higher value manifested by statistically significant lower LOS (p<0.01), PC (p<0.01), RA (p<0.05), at a TC of $24,800 vs. $29,021 (p<0.05). Domain surrogates for service line are summarized in Table 1. While age, type of procedure (mesh vs no mesh), and comorbidities such as CAD, CHF and DM showed a significant effect on the occurrence of postoperative complications by univariate modeling, only age and type of procedure predicted complications by multivariate analyses.
CONCLUSION. Umbilical/epigastric hernia repairs showed a high value as a service line (OP or MI) in our Health System Network. Although mesh placement has a short-term high value, long-term value and hernia recurrence rates are being determined.
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