title: Cost-effectiveness of primary abdominal wall hernia repair in a 364-bed provincial hospital of Spain.
abstract: OBJECTIVE
  Primary abdominal hernia is a prevalent condition that weighs heavily on human and financial health-care resources (e.g., 1.12% of the total budget of our hospital in 2008). Tension-free hernioplasty is the standard repair procedure, but the anesthetic technique varies, including local anesthesia with sedation (Lsed), regional (Reg), and general (Gen) anesthesia. As the cost-outcome relation of different anesthetic options has never been examined in our health district, we proposed to identify the most cost-effective anesthetic technique out of three options for primary abdominal hernia repair in terms of clinical outcome and health-care economics in this retrospective review.
  
  
  METHODS
  The study sample of 400 patients with primary abdominal hernia in 2008 underwent tension-free hernioplasty using one of three anesthetic techniques: 74 Lsed, 283 Reg, and 43 Gen. The comparability of outcomes was ensured by dividing the sample into homogeneous groups according to the American Society of Anesthesiologists Physical Status classification (ASA 1 and 2) and adjusting for technical complexity, risk factors, and anatomic location.
  
  
  RESULTS
  The clinical outcome of hernioplasty with Lsed was significantly better in terms of shorter hospital stay, lower early- and intermediate-term complication rate, and shorter time to recovery after discharge. The short-term recurrence rate did not differ between groups. The mean cost per hernioplasty procedure was <euro>3,270.37 (Lsed), <euro>4,740.37 (Reg), and <euro>7,318.44 (Gen).
  
  
  CONCLUSIONS
  The cost-effectiveness and incremental cost per patient showed the advantage of hernioplasty with Lsed versus Reg (<euro>794.59) and Lsed versus Gen (<euro>704.01), respectively.
authors.affiliation: Department of General and Digestive Surgery, Hospital Virgen de la Luz, SESCAM, c/Hermandad Donantes de Sangre s/n, 16003, Cuenca, Spain. ricardod@sescam.org
authors.forename: R de Miguel
authors.initials: Rde M
authors.lastname: Ibañez
authors.forename: S A Nahban
authors.initials: SA
authors.lastname: Al Saied
authors.forename: J Alonso
authors.initials: JA
authors.lastname: Vallejo
authors.forename: J M Rodríguez
authors.initials: JM
authors.lastname: Canales
authors.forename: C Blanco
authors.initials: CB
authors.lastname: Prieto
authors.forename: F Escribano
authors.initials: FE
authors.lastname: Sotos
mesh_terms: D000768:Anesthesia, General / Q000191:economics*; D000772:Anesthesia, Local / Q000191:economics*; D000775:Anesthesia, Spinal / Q000191:economics*; D016292:Procedural Sedation / Q000191:economics*; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006261:Headache / Q000209:etiology; D006297:Health Services Accessibility / Q000191:economics; D006406:Hematoma / Q000209:etiology; D046449:Hernia, Abdominal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D012189:Retrospective Studies; D013030:Spain; D013530:Surgical Wound Infection / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology