Value Improvement and Resource Utilization in Complex Abdominal Wall Reconstruction

Although recommendations help guide surgeons’ mesh choice in abdominal wall reconstruction (AWR), financial and institutional pressures may play a bigger role. Standardization of an AWR algorithm may help reduce costs and change mesh preferences. We performed a retrospective review of high- and low-...

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Bibliographic Details
Published in:The American surgeon 2019-10, Vol.85 (10), p.1113-1117
Main Authors: Mayfield, Cory K., Gould, Daniel J., Wong, Alex, Patel, Ketan M., Carey, Joseph
Format: Article
Language:English
Subjects:
Abdomen
Abdominal wall
Algorithms
Biological products
Complications
Contamination
Cost analysis
Fistula
Hernias
Hospital costs
Immunosuppression
Infections
Resource utilization
Risk
Standardization
Surgeons
Surgery
Systematic review
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Summary:Although recommendations help guide surgeons’ mesh choice in abdominal wall reconstruction (AWR), financial and institutional pressures may play a bigger role. Standardization of an AWR algorithm may help reduce costs and change mesh preferences. We performed a retrospective review of high- and low-risk patients who underwent inpatient AWR between 2014 and 2016. High risk was defined as immunosuppression and/or history of infection/contamination. Patients were stratified by the type of mesh as biologic/biosynthetic or synthetic. These cohorts were analyzed for outcome, complications, and cost. One hundred twelve patients underwent complex AWR. The recurrence rate at two years was not statistically different between high- and low-risk cohorts. No significant difference was found in the recurrence rate between biologic and synthetic meshes when comparing both high- and low-risk cohorts. The average cost of biologic mesh was $9,414.80 versus $524.60 for synthetic. The estimated cost saved when using synthetic mesh for low-risk patients was $295,391.20. In conclusion, recurrence rates for complex AWR seem to be unrelated to mesh selection. There seems to be an excess use of biologic mesh in low-risk patients, adding significant cost. Implementing a critical process to evaluate indications for biologic mesh use could decrease costs without impacting the quality of care, thus improving the overall value of AWR.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313481908501008