Incisional Hernia in the United States: Trends in Hospital Encounters and Corresponding Healthcare Charges

Abstract

Incisional hernia (IH) is a challenging, potentially morbid condition. This study evaluates recent trends in hospital encounters associated with IH care in the United States. Using Nationwide Inpatient Sample databases from 2007 to 2011, annual estimates of IH-related hospital discharges, charges, and serious adverse events were identified. Significance in observed trends was tested using regression modeling. From 2007 to 2011, there were 583,054 hospital discharges associated with a diagnosis of IH. 81.1 per cent had a concurrent procedure for IH repair. The average discharge included a female patient (63.2%), 59.8 years of age, with either Medicare (45.3%) or Private insurance (38.3%) as the anticipated primary payer. Comparing 2007 to 2011, significant increases in IH discharges (12%; 2007 = 109,702 vs 2011 = 123,034, P = 0.009) and IH repairs (10%; 2007 = 90,588 vs 2011 = 99,622, P < 0.001) were observed. This was accompanied by a 37 per cent increase in hospital charges (2007 = $44,587 vs 2011 = $60,968, P < 0.001), resulting in a total healthcare bill of $7.3 billion in 2011. Significant trends toward greater patient age (2007 = 59.7 years vs 2011 = 60.2 years, P < 0.001), higher comorbidity index (2007 = 3.0 vs 2011 = 3.5, P < 0.001), and increased frequency of serious adverse events (2007 = 13.5% vs 2011 = 17.7%, P < 0.001) were noted. Further work is needed to identify interventions to mitigate the risk of IH development.

National health disparities in incisional hernia repair outcomes: An analysis of the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2012-2014

“…This analysis estimated IHR hospital charges of 6.3 billion US dollars per year. Annual charge estimates matched those reported 4 In contrast to the previous study, our study reports lower total numbers of annual repairs, possibly due to more stringent selection of ICD-9 procedural codes for IHRs. Additionally, over the 3-year period included in this study, annual IHR numbers decreased (Table II).…”

“…It is unclear whether this trend is the result of increased conservative medical management of IH, decreased IH incidence, or alterations in the coding of IHR procedures. Yet IHR-associated hospital charges, averaging $71,811 per patient, are higher than previously reported averages, 4,27 contributing to the continued burden that IH places on the health care system, patients, and providers. Additionally, this burden is unevenly distributed as average hospital charges per patient was 47% higher in nonelective repairs ($90,537 vs $61,533), which are more prevalent in non-White and nonprivate insurance patients.…”

“…From 2007 to 2011, the national incidence of new IH increased 2.9% annually. 4 This is attributed to the rising prevalence of IH risk factors such as obesity, smoking, and diabetes.…”

“…9e12 For payors, IH-related costs exceeded $7.3 billion in 2011. 4 For providers, IH are an unwanted complication and can be difficult to repair. Compared to primary ventral hernias, IH repairs (IHR) require significantly longer operative times (median 170 vs 77 minutes), and IH are significantly more likely to reoccur (odds ratio [OR] 4.79) and require reoperation (OR 3.86).…”

Biological Scaffolds for Abdominal Wall Repair: Future in Clinical Application?

“…While the number of non-incisional hernias is constant, the prevalence of incisional hernia repairs is increasing yearly [4]. Health care costs in the US for both ventral and incisional hernia repairs are estimated at more than $10 billion/year, which is a cost that will increase over time because of increasing patient age and a consequential higher frequency of comorbidities and adverse events [5,6].…”