Cost analysis of inguinal hernia repair: the influence of clinical and hernia-specific factors

Abstract

Introduction As in the rest of the world, in Germany, inguinal hernia operations are among the most common operations. From an economic standpoint, very little is known about the influence of demographic, clinical or hernia-related parameters on the cost of inguinal hernia repair. We, therefore, evaluated individual patient parameters associated with higher costs with a special focus on multimorbidity. Methods A total of 916 patients underwent hernia repair for primary or recurrent inguinal hernia between 2014 and 2017 at a single university center and were included in the analysis. The clinical and financial data of these patients were analyzed to identify cost-increasing parameters. Results A majority of patients were male (90.7%), with a mean age of 55 years. The surgical methods utilized were mainly the TAPP (57.2%) and Lichtenstein (41.7%) procedures, with an average duration of surgery of 85 min and an average duration of anesthesia of 155 min. The mean cost of all procedures was 3338.3 € (± 1608.1 €). Older age, multimorbidity, emergency operations with signs of incarceration, longer hospital stays and postoperative complications were significant cost-driving factors. On the other hand, sex, the side of the hernia (left vs. right) and the presence of recurrent hernias had no influence on the overall direct costs. Conclusion From a purely economic point of view, older age and multimorbidity are demographic cost-driving factors that cannot be influenced. The national hospital reimbursement system needs to consider and compensate for these factors. Emergency operations need to be prevented by early elective treatment. Long postoperative stays and postoperative complications need to be prevented by proper preoperative check-ups and accurate treatment.

Comparison of the Analgesic Effect of Subcutaneous Bupivacaine Infiltration and Intravenous Diclofenac vs. Intravenous Diclofenac Monotherapy After Inguinal Hernioplasty: A Retrospective Study

“…Males are 25 times more likely to have inguinal hernia than females; this observation is consistent with our findings. The mean age of patients in our study was 36 ± 11 years, which contradicts the previous studies that showed that the mean patient age was above 49 years [10,11]. To the best of our knowledge, this may allude to the patient's health education level and early engagement with the healthcare system.…”

Short-Term Outcomes of Inguinal Hernia Repair in Older Patients: A Retrospective Review at a Tertiary Center

“…We reported a higher operative time (17 ± 47.2 minutes) and length of hospitalization (2.42 ± 3.48 days) than has been reported in the literature [10,12,17,18]. Our hospital admission policy and the fact that it is an educational institution can explain this difference.…”

Nationwide analysis of laparoscopic groin hernia repair in Italy from 2015 to 2020

“…In addition to the technical difficulties and a long learning curve, in Italy, a further obstacle to the spread of the laparoscopic technique has been the remuneration of the operation that, regardless of whether the hernia was monolateral, bilateral or recurrent, is remunerated in the same way as a monolateral open hernioplasty. Although some recent studies have reported advantages in healthcare expenditure for laparoendoscopic procedures, this figure is probably distorted by the type of healthcare system adopted in each country [ 16 , 17 ]. In some countries, the healthcare systems are welfarist, while in others, they are purely insurance-based, and in others still, they are mixed, so the impact of the reimbursement system could affect the push for health insurance in different ways.…”

“…A recent paper by Aydin et al showed that the cost of an anterior approach is similar to TAPP. However, the costs of hospital stay and anesthesia for each type of procedure are not reported, and bilateral and recurrence are compared [ 17 ]. The preperitoneal and transperitoneal approach does not seem to be related to a difference in expenditure.…”

“…Year country [16,17]. In some countries, the healthcare systems are welfarist, while in others, they are purely insurancebased, and in others still, they are mixed, so the impact of the reimbursement system could affect the push for health insurance in different ways.…”