title: Trends in open abdominal surgery in the United States-Observations from 9,950,759 discharges using the 2009-2013 National Inpatient Sample (NIS) datasets.
abstract: BACKGROUND
  Incisional hernia (IH) represents a complex and costly surgical complication. We aim to address trends in open surgery to better understand potential drivers of hernia risk.
  
  
  METHODS
  Using the 2009-2013 NIS, a cross-sectional review of hospital discharges associated with an open abdominal surgery was performed.
  
  
  RESULTS
  Between 2009 and 2013, there were nearly 10 million discharges associated with an open abdominal surgery. Overall, there were 2,140,616 patients receiving open surgery in 2009, decreasing to 1,760,549 in 2013 (18% decrease, p < 0.001). Open hernia procedures increased from 37,325 patients in 2009 to 41,845 in 2013 (12% increase, p = 0.001). The most prevalent comorbidities within this population included uncomplicated hypertension (25.26%), chronic pulmonary diseases (13.52%), obesity (10.24%), uncomplicated diabetes (11.06%), and depression (10.72%).
  
  
  CONCLUSIONS
  Our analysis allowed for a unique view of surgical trends, health care population dynamics, and an opportunity to use evidence-driven analytics in the understanding of IH.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Carney
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Weissler
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Fox
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Tecce
authors.affiliation: Department of Biostatistics, Wharton School of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jesse Y
authors.initials: JY
authors.lastname: Hsu
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: John.Fischer2@uphs.upenn.edu.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
mesh_terms: D000005:Abdomen / Q000601:surgery*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D059685:Herniorrhaphy / Q000706:statistics & numerical data; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data* / Q000639:trends*; D013997:Time Factors; D014481:United States
keywords: Epidemiology; Health services research; Incisional hernia; Laparotomy