title: A risk model and cost analysis of post-operative incisional hernia following 2,145 open hysterectomies-Defining indications and opportunities for risk reduction.
abstract: BACKGROUND
  Incisional hernia (IH) is a complication following open abdominal hysterectomy. This study addresses the incidence and health care cost of IH repair after open hysterectomy, and identify perioperative risk factors to create predictive risk models.
  
  
  METHODS
  We conduct a retrospective review of patients who underwent open hysterectomy between 2005 and 2013 at the University of Pennsylvania. The primary outcome was post-hysterectomy IH. Univariate/multivariate cox proportional hazard analyses identified perioperative risk factors. We performed cox hazard regression modeling with bootstrapped validation, risk stratification, and assessment of model performance.
  
  
  RESULTS
  2145 patients underwent open hysterectomy during the study period. 76 patients developed IH, and all underwent repair. 31.3% underwent reoperation, generating higher costs ($71,559 vs. $23,313, p < 0.001). 8 risk factors were included in the model, the strongest being presence of a vertical incision (HR = 3.73 [2.01-6.92]). Extreme-risk patients experienced the highest incidence of IH (22%) vs. low-risk patients (0.8%) [C-statistic = 0.82].
  
  
  CONCLUSIONS
  We identify perioperative risk factors for IH and provide a risk prediction instrument to accurately stratify patients in effort to offer risk reductive techniques.
  
  
  CONCLUSIONS
  Open hysterectomies account for a magnitude of surgical procedures worldwide. This study presents an internally validated risk model of IH in patients undergoing open hysterectomy after a review of 2145 cases. With an increasing emphasis on prevention in healthcare, we create a risk model to improve outcomes after open hysterectomies in effort to identify high-risk patients, facilitate preoperative risk counseling, and implement evidence-based strategies to improve outcomes.
authors: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors: Michael G
authors: MG
authors: Tecce
authors: Division of Plastic Surgery, Department of Surgery, Brown Alpert School of Medicine, Providence, RI, USA.
authors: Marten N
authors: MN
authors: Basta
authors: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors: Valeriy
authors: V
authors: Shubinets
authors: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors: Michael A
authors: MA
authors: Lanni
authors: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors: Michael N
authors: MN
authors: Mirzabeigi
authors: Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors: Laura
authors: L
authors: Cooney
authors: Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors: Suneeta
authors: S
authors: Senapati
authors: Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors: Ashley F
authors: AF
authors: Haggerty
authors: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors: Jason M
authors: JM
authors: Weissler
authors: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors: J Andres
authors: JA
authors: Hernandez
authors: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA. Electronic address: John.Fischer2@uphs.upenn.edu.
authors: John P
authors: JP
authors: Fischer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000191:economics; D000069290:Incisional Hernia / Q000191:economics* / Q000453:epidemiology* / Q000517:prevention & control; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior
keywords: Abdominal surgery; Hernia; Hernia repair; Hysterectomy; Risk model; Risk predictions