William H. Nealon

Epidemiology and cost of ventral hernia repair: making the case for hernia research

PurposeVentral hernia repair (VHR) lacks standardization of care and exhibits variation in delivery. Complications of VHR, notably recurrence and infection, increase costs. Efforts at obtaining federal funding for VHR research are frequently unsuccessful, in part due to misperceptions that VHR is not a clinical challenge and has minimal impact on healthcare resources. We analyzed national trends for VHR performance and associated costs to demonstrate potential savings resulting from an improvement in outcomes.MethodsInpatient non-federal discharges for VHR were identified from the 2001–2006 Healthcare Cost and Utilization Project, supplemented by the Center for Disease Control 2006 National Survey of Ambulatory Surgery for outpatient estimates. The total number of VHRs performed in the US was estimated along with associated costs. Costs were standardized to 2010 US dollars using the Consumer Price Index and reported as mean with 95% confidence intervals (95% CI).ResultsThe number of inpatient VHRs increased from 126,548 in 2001 to 154,278 in 2006. Including 193,543 outpatient operations, an estimated 348,000 VHRs were performed for 2006. Inpatient costs consistently rose with 2006 costs estimated at USxa0

Prospective Evaluation of Surgeon Physical Examination for Detection of Incisional Hernias

15,899 (95% CI

Comparative Effectiveness of Dynamic Abdominal Sonography for Hernia vs Computed Tomography in the Diagnosis of Incisional Hernia

15,394–

Postoperative Care Using a Secure Online Patient Portal: Changing the (Inter)Face of General Surgery

16,404) per operation. Estimated cost for outpatient VHR was USxa0

Comparative Evaluation of Dynamic Abdominal Sonography for Hernia and Computed Tomography for Characterization of Incisional Hernia

3,873 (95% CI

Previous Methicillin-Resistant Staphylococcus aureus Infection Independent of Body Site Increases Odds of Surgical Site Infection after Ventral Hernia Repair.

2,788–

Predicting complicated choledocholithiasis.

4,958). The total cost of VHR for 2006 was USxa0

An Urban-Rural Blight? Choledocholithiasis Presentation and Treatment

3.2xa0billion.ConclusionsVHRs continue to rise in incidence and cost. By reducing recurrence rate alone, a cost saving of USxa0

Choledocholithiasis Management in Rural America: Health Disparity or Health Opportunity?

32 million dollars for each 1% reduction in operations would result. Further research is necessary for improved understanding of ventral hernia etiology and treatment and is critical to cost effective healthcare.

Patient Safety in the Era of the 80-Hour Workweek

BACKGROUNDnSurgeon physical examination is often used to monitor for hernia recurrence in clinical and research settings, despite a lack of information on its effectiveness. This study aims to compare surgeon-reviewed CT with surgeon physical examination for the detection of incisional hernia.nnnSTUDY DESIGNnGeneral surgery patients with an earlier abdominal operation and a recent viewable CT scan of the abdomen and pelvis were enrolled prospectively. Patients with a stoma, fistula, or soft-tissue infection were excluded. Surgeon-reviewed CT was treated as the gold standard. Patients were stratified by body mass index into nonobese (body mass index <30) and obese groups. Testing characteristics and real-world performance, including positive predictive value and negative predictive value, were calculated.nnnRESULTSnOne hundred and eighty-one patients (mean age 54 years, 68% female) were enrolled. Hernia prevalence was 55%. Mean area of hernias was 44.6 cm(2). Surgeon physical examination had a low sensitivity (77%) and negative predictive value (77%). This difference was more pronounced in obese patients, with sensitivity of 73% and negative predictive value 69%.nnnCONCLUSIONSnSurgeon physical examination is inferior to CT for detection of incisional hernia, and fails to detect approximately 23% of hernias. In obese patients, 31% of hernias are missed by surgeon physical examination. This has important implications for clinical follow-up and design of studies evaluating hernia recurrence, as ascertainment of this result must be reliable and accurate.