title: The increased cost of ventral hernia recurrence: a cost analysis.
abstract: OBJECTIVE
  Over 300,000 ventral hernia repairs (VHRs) are performed each year in the US. We sought to assess the economic burden related to ventral hernia recurrences with a focused comparison of those with the initial open versus laparoscopic surgery.
  
  
  METHODS
  The Premier Alliance database from 2009 to 2014 was utilized to obtain patient demographics and comorbid indices, including the Charlson comorbidity index (CCI). Total hospital cost and resource expenses during index laparoscopic and open VHRs and subsequent recurrent repairs were also obtained. The sample was separated into laparoscopic and open repair groups from the initial operation. Adjusted and propensity score matched cost outcome data were then compared amongst groups.
  
  
  RESULTS
  One thousand and seventy-seven patients were used for the analysis with a recurrence rate of 3.78 %. For the combined sample, costs were significantly higher during recurrent hernia repair hospitalization ($21,726 versus $19,484, p < 0.0001). However, for index laparoscopic repairs, both the adjusted total hospital cost and department level costs were similar during the index and the recurrent visit. The costs and resource utilization did not go up due to recurrence, even though these patients had greater severity during the recurrent visit (CCI score 0.92 versus 1.06; p = 0.0092). Using a matched sample, the total hospital recurrence cost was higher for the initial open group compared to laparoscopic group ($14,520 versus $12,649; p = 0.0454).
  
  
  CONCLUSIONS
  Based on our analysis, need for recurrent VHR adds substantially to total hospital costs and resource utilization. Following initial laparoscopic repair, however, the total cost of recurrent repair is not significantly increased, as it is following initial open repair. When comparing the initial laparoscopic repair versus open, the cost of recurrence was higher for the prior open repair group.
authors.affiliation: Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Davila
authors.affiliation: Department of Economic Studies, Medtronic, Minneapolis, USA.
authors.forename: N
authors.initials: N
authors.lastname: Parikh
authors.affiliation: Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Frelich
authors.affiliation: Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA. mgoldbla@mcw.edu.
authors.forename: M I
authors.initials: MI
authors.lastname: Goldblatt
mesh_terms: D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005260:Female; D006555:Hernia, Ventral / Q000191:economics* / Q000601:surgery; D059685:Herniorrhaphy / Q000191:economics* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008297:Male; D008875:Middle Aged; D012008:Recurrence
keywords: Cost; Cost analysis; Laparoscopy; Recurrence; Ventral hernia