title: Analysis of perioperative factors associated with increased cost following abdominal wall reconstruction (AWR).
abstract: BACKGROUND
  Ventral hernias are a common, challenging, and expensive problem for both the general and reconstructive surgeons; therefore, the aim of this study is to critically assess perioperative factors related to cost in abdominal wall reconstructions (AWR).
  
  
  METHODS
  A retrospective review of AWR patients from 2007 and 2012 was performed. Analysis of perioperative factors associated with total cost of reconstruction was performed. Linear regression analyses were used to assess independent predictors of total cost.
  
  
  RESULTS
  134 consecutive AWR performed by a single surgeon over a 5-year period at an academic teaching center were included. The average total cost of AWR was $61,251 ± 55,624. Linear regression analysis demonstrated that diabetes (P = 0.026), increased American Society of Anesthesiologists score (P = 0.002), preoperative anemia (P = 0.001), and hernias derived from trauma (P = 0.015) were independently associated with added cost in AWR when controlling for confounding variables. In addition, patients requiring intra-abdominal procedures (P = 0.012) and those receiving an AWR using Acellular Dermal Matrix (P = 0.015) accrued significantly greater cost. Interestingly, preoperative placement of an epidural (P = 0.011) was independently associated with significant cost savings and reduced medical morbidity. Major surgical complications (P < 0.001) and length of stay (P < 0.001) were independently associated with increased cost following AWR.
  
  
  CONCLUSIONS
  We present a critical assessment of cost in AWR at a major academic teaching hospital and quantify the impact of reconstruction in the setting of medical morbidities and reconstructive complexities. The data from this study can be used to adjust reimbursement schemes and to critically assess the cost-benefit of performing AWR.
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania at the Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA, John.Fischer2@uphs.upenn.edu.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.forename: Ari M
authors.initials: AM
authors.lastname: Wes
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wink
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.forename: Jeff I
authors.initials: JI
authors.lastname: Rohrbach
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Braslow
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D005260:Female; D017048:Health Care Costs; D006555:Hernia, Ventral / Q000191:economics* / Q000601:surgery*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000191:economics*; D012189:Retrospective Studies