title: Impact of the establishment of a specialty hernia referral center.
abstract: BACKGROUND
  Creating a surgical specialty referral center requires a strong interest, expertise, and a market demand in that particular field, as well as some form of promotion. In 2004, we established a tertiary hernia referral center. Our goal in this study was to examine its impact on institutional volume and economics.
  
  
  METHODS
  The database of all hernia repairs (2004-2011) was reviewed comparing hernia repair type and volume and center financial performance. The ventral hernia repair (VHR) patient subset was further analyzed with particular attention paid to previous repairs, comorbidities, referral patterns, and the concomitant involvement of plastic surgery.
  
  
  RESULTS
  From 2004 to 2011, 4927 hernia repairs were performed: 39.3% inguinal, 35.5% ventral or incisional, 16.2% umbilical, 5.8% diaphragmatic, 1.6% femoral, and 1.5% other. Annual billing increased yearly from 7% to 85% and averaged 37% per year. Comparing 2004 with 2011, procedural volume increased 234%, and billing increased 713%. During that period, there was a 2.5-fold increase in open VHRs, and plastic surgeon involvement increased almost 8-fold, (P = .004). In 2005, 51 VHR patients had a previous repair, 27.0% with mesh, versus 114 previous VHR in 2011, 58.3% with mesh (P < .0001). For VHR, in-state referrals from 2004 to 2011 increased 340% while out-of-state referrals jumped 580%. In 2011, 21% of all patients had more than 4 comorbidities, significantly increased from 2004 (P = .02).
  
  
  CONCLUSIONS
  The establishment of a tertiary, regional referral center for hernia repair has led to a substantial increase in surgical volume, complexity, referral geography, and financial benefit to the institution.
authors.affiliation: Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Kristopher B
authors.initials: KB
authors.lastname: Williams
authors.affiliation: Anne Arundel Medical Center, Annapolis, MD, USA.
authors.forename: Igor
authors.initials: I
authors.lastname: Belyansky
authors.affiliation: Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Kristian T
authors.initials: KT
authors.lastname: Dacey
authors.affiliation: Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Yuliya
authors.initials: Y
authors.lastname: Yurko
authors.affiliation: Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Vedra A
authors.initials: VA
authors.lastname: Augenstein
authors.affiliation: Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lincourt
authors.affiliation: Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: James
authors.initials: J
authors.lastname: Horton
authors.affiliation: Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Kent W
authors.initials: KW
authors.lastname: Kercher
authors.affiliation: Carolinas Medical Center, Charlotte, NC, USA todd.heniford@carolinashealthcare.org.
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D003365:Costs and Cost Analysis; D016208:Databases, Factual; D006268:Health Facilities; D059685:Herniorrhaphy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D009657:North Carolina; D012017:Referral and Consultation; D013043:Specialties, Surgical / Q000458:organization & administration*
keywords: financial impact; hernia; hernia center; hernia repair; inguinal hernia; laparoscopic ventral hernia; open ventral hernia; surgical volume; ventral hernia