Incidence, risk factors, and burden of incisional hernia repair after abdominal surgery in France: a nationwide study

Abstract

Purpose Incisional hernias are common after laparotomies. The aims of this study were to assess the rate of incisional hernia repair after abdominal surgery, recurrence rate, hospital costs, and risk factors, in France. Methods This national, retrospective, longitudinal, observational study was based on the exhaustive hospital discharge database (PMSI). All adult patients (≥ 18 years old) hospitalised for an abdominal surgical procedure between 01-01-2013 and 31-12-2014 and hospitalised for incisional hernia repair within five years were included. Descriptive analyses and cost analyses from the National Health Insurance (NHI) viewpoint (hospital care for the hernia repair) were performed. To identify risk factors for hernia repair a multivariable Cox model and a machine learning analysis were performed. Results In 2013–2014, 710074 patients underwent abdominal surgery, of which 32633 (4.6%) and 5117 (0.7%) had ≥ 1 and ≥ 2 incisional hernia repair(s) within five years, respectively. Mean hospital costs amounted to €4153/hernia repair, representing nearly €67.7 million/year. Some surgical sites exposed patients at high risk of incisional hernia repair: colon and rectum (hazard ratio [HR] 1.2), and other sites on the small bowel and the peritoneum (HR 1.4). Laparotomy procedure and being ≥ 40 years old put patients at high risk of incisional hernia repair even when operated on low-risk sites such as stomach, duodenum, and hepatobiliary. Conclusion The burden of incisional hernia repair is high and most patients are at risk either due to age ≥ 40 or the surgery site. New approaches to prevent the onset of incisional hernia are warranted.

Incidence, Healthcare Resource Use and Costs Associated With Incisional Hernia Repair

“…This retrospective review of population-level data from England describes the post-operative journey that patients undergo following abdominal surgery in England. A recent publication from the French national database estimated the cost of incisional hernia repair to be €4,153 per repair, in keeping with other publications [ 11 ]. Our paper is the first, however, to describe the morbidity and cost incurred to patients between their index surgery and repair.…”

“…Patients with incisional hernia report significantly lower quality of life and body image scores compared to patients without [ 9 ]. Furthermore, operative repair of incisional hernia is challenging, carrying high recurrence rates and an overall mortality rate of 1% [ 10 , 11 ]. Patients undergoing repair of incisional hernia may enter a vicious cycle of recurrence and re-operation with increasingly poor outcomes with each attempt [ 12 ].…”

O risco de reincidência de eventração incisional após hernioplastia: uma revisão narrativa

“…Com taxas de incidência chegando a 15% nos pacientes laparotomizados, as complicações abrangem morbidade substancial, perda de qualidade de vida, necessidade de intervenções cirúrgicas futuras e despesas adicionais (ORTEGA- DEBALLON, et. al., 2023).…”

The Safety of Incisional Hernia Surgical Repair in Patients ≥70 Years

“…IH is one of the most common surgical presentations to general surgical teams and represents a challenge in terms of management options and costs [ 14 ]. A recent French publication [ 15 ] studied the patients who had abdominal surgery in 2013-2014. Out of 710,074 patients, 32,633 (4.6%) and 5117 (0.7%) had ≥1 and ≥2 incisional hernia repair(s) within five years of follow-up, respectively.…”