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PRELIMINARY VALUE AND COST ANALYSES FOR EPIGASTRIC AND UMBILICAL HERNIA REPAIR PROCEDURES OVER A 10-YEAR PERIOD AT A TERTIARY MEDICAL CENTER
Michael Abdelmasseh*1,2, Arslan Iqbal1,2, Errington C. Thompson1,2, Semeret Munie1,2, Robert Finley3, Barbara Payne1,2, Cierra King2, Grace Montgomery2, Jay Jensen2, Jonathan Willis4,2, Vineela Kadiyala4,2, Juan Sanabria1,2,5
1Department of Surgery and Marshall Institute for Interdisciplinary Research (MIIR), Huntington, WV; 2Joan C Edwards School of Medicine at Marshall University, Huntington, WV; 3Hershel Woody Williams VA Medical Center, Huntington, WV; 4Department of Informatics and Biostatistics, Huntington, WV; 5Department of Nutrition and Metabolomics Core Facility, Case Western Reserve University, Cleveland, OH

BACKGROUND. Nearly 17500 umbilical and epigastric hernia repairs are performed in the US annually. Healthcare providers and stakeholders suggest new strategies to spotlight the importance of connecting reimbursement to performance. We aim to assess the value of umbilical and epigastric hernia repair procedures and determine the factors that affect their cost.
METHODS. Clinical variables (v=81) from patients (>18yo) who underwent umbilical and epigastric hernia repair were retrieved from a Health System warehouse retrospectively (Jan-2010 to July-2016, n=264), and prospectively (Aug-2016 to Dec-2019, n=224) under IRB approved protocols. Quality was assessed by grading surgical complications using a Classification System where Uncomplicated = 1 value unit, Grade 1 = 0.95, Grade 2 = 0.75, Grade 3 = 0.60, Grade 4 = 0.50, Grade 5 = 0 (death). Cost was defined as total hospital charges accrued for admission/re-admission up to 30days post-discharge and corrected for inflation at a 5% APR. Univariate and multivariate analyses were performed using MATLAB software.
RESULTS. A total of 488 patients underwent open (68%) vs laparoscopic (32%) umbilical and epigastric hernia repairs with a gender distribution ratio of 3:2 for males vs. females. The mean age of the study population was 49'13.6 and the mean BMI was 35'8 with a 0.6% readmission rate. The unit value cost of uncomplicated outpatient open umbilical and epigastric hernia repair with no readmission was $18,314 (value unit=1). The mean overall cost was $23,282'12,306. Figure 1 describes the average/year costs of open vs laparoscopic epigastric and umbilical hernia repairs (p<0.05). Univariate and multivariate analyses were calculated to predict the variables that affect the value and cost.
CONCLUSION. Open epigastric and umbilical hernia repairs have a higher value and lower cost compared to laparoscopic procedures in our series.


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