OBJECTIVES

: Open incisional hernia (OIH) repair with absorbable barrier flat mesh (ABM) and suture is associated with some challenges which include the size of the incision and the amount of dissection needed to place and secure the mesh. Absorbable barrier mesh designed with pockets (ABPM) address some of these challenges by allowing the mesh to be inserted and positioned through a small incision, and secured in place using a hernia tacker, minimizing or eliminating the need for suture. The purpose of this analysis is to compare surgery time (ST), total cost of care (TCC), length of stay (LOS), mesh average selling price (ASP) and tacker use frequency for OIH repairs using ABPM versus ABM in the hospital setting, both inpatient (IP) and outpatient (OP).

METHODS

: A retrospective comparison of hospital based OIH repairs performed between Q1 2013 and Q1 2017 using ABPM vs. ABM was completed using the Premier Healthcare Database with detailed insights from over 700 U.S. hospitals. Associated CPT, ICD-9, and ICD-10 procedure codes were identified. Propensity score matching was used to balance observed differences in various confounding factors associated with clinical outcomes.

RESULTS : The database contained 1,888 (995 IP, 893 OP) OIH repairs using ABPM or ABM. After propensity score matching, data for both surgical settings showed a lower mean ST (p<0.001, minutes) for ABPM vs. ABM, (126 vs. 161 IP, n=207 and 82 vs. 118 OP, n=213), and lower TCC (p<0.001) for ABPM vs. ABM ($11,437 vs. $15,889 IP, n=205 and $4,776 vs. $7,243 OP, n=214). LOS was not significantly different. Tacker use was more frequent with ABPM vs. ABM (36% vs. 14% IP and 32% vs. 20% OP).

CONCLUSIONS : The use of ABPM vs. ABM for OIH repairs is associated with a significantly shorter ST and lower TCC in both the inpatient and outpatient setting.