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Have outcomes of incisional hernia repair improved with time? A population-based analysis
David R Flum1, Karen Horvath, Thomas Koepsell
1Robert Wood Johnson Clinical Scholars Program, Seattle, Washington, USA. daveflum@u.washington.edu
Objective:
To determine if certain outcomes of incisional hernia repair have improved in recent eras.
Summary Background Data:
Technological developments have been reported to improve outcomes in the repair of abdominal wall incisional hernias.
Methods:
This retrospective, population-based cohort study was conducted using a 1987 to 1999 Washington hospital discharge database. Subjects were all Washington state residents assigned ICD9 procedure codes for incisional hernia repair with or without synthetic material (mesh). Main outcome measure was the rate of reoperative incisional hernia repair, length of hospitalization, and hospital charges based on the use of synthetic material and the era of operative repair (before and after 1995).
Results:
A total of 10,822 Washington state patients underwent incisional hernia repair (mean age 58.7 +/- 15.6, 64% female). Of patients undergoing incisional hernia repair, 12.3% underwent at least one subsequent reoperative incisional hernia repair within the first 5 years after initial repair (23.1% at 13 years follow-up). The 5-year reoperative rate was 23.8% after the first reoperation, 35.3% after the second, and 38.7% after the third. The use of synthetic mesh in incisional hernia repairs increased from 34.2% in 1987 to 65.5% in 1999. When controlling for age, sex, comorbidity index of the patient, year of the initial procedure, and hospital descriptors (rural location, nonprofit and teaching status), the hazard for recurrence was 24.1% higher if no mesh was used compared to the hazard if mesh was used. After similar adjustment, no differences were found in the hazard of reoperation based on the era of the operative repair. Mean length of stay for procedures performed after 1995 was 4.9 days compared to 4.8 days in preceding eras.
Conclusions:
Incisional hernia repair is associated with high cumulative rates of reoperative repairs. The expectation that important measures of adverse outcome have improved in recent eras is not supported by the results of this large population-based study.