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Open ventral hernia repair (OVHR) is performed by surgeons of differing training and with varying techniques. Although most OVHRs are performed by general surgeons (GS), plastic surgeons (PS) also perform them. Techniques and principles previously developed by plastic surgeons to assist with OVHR have been adopted by GS, who are now performing them independently. The impact of speciality training upon OVHR practices is not well understood. We hypothesized that surgeon specialty, surgeon volume, and hospital volume would be predictors of surgical complications, mortality, extended hospital stay, and total charge.
Methods
Retrospective analysis was performed using data from the National Inpatient Sample (NIS) from 2001 to 2009. Patients undergoing open ventral hernia repair (OVHR) were identified using ICD-9 codes. Unique surgeon identifiers were used to quantify OVHR case volume and identify surgeon specialty. Non-elective cases and those involving additional hernia repairs or GI resections were excluded.
Multivariate regression modeling was used to characterize the association between patient, hospital, and surgeon factors with surgical complications, total charge, length of hospital stay, and in-hospital mortality. Patient age, gender, obesity status, Charlson comorbidity score, payment type, admission source, location, hospital teaching status and region, and total number of concurrent diagnosis and procedure codes were included as covariates in the multivariate models.
Results
A total of 77,572 open ventral hernia repairs were included in the analysis. 7.1% of cases were performed by PS and 92.9% by GS. PS were associated with decreased odds of extended length of stay (OR=0.72, p<0.001), surgical complications (OR=0.71, p<0.01), and death (OR=0.40, p<0.05). PS were also a significant predictor of lower total hospital charge (Beta=-3151.3, p<0.001). High volume hospitals were associated with greater total charge (Beta=1709.7, p<0.001) and increased odds of extended LOS (OR=1.09, p<0.01), but lower risk for complications (OR=0.90, p=0.001).
Conclusions
In this analysis, PS was identified as a predictive factor in the quality and efficiency of OVHR, as PS patients had shorter hospital stays, fewer surgical complications or deaths, and lower total charge. Additionally, high volume surgeons and hospitals were both associated with reduced risk for complications of surgery.