Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA.
Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Am J Surg. 2020 Jan;219(1):110-116. doi: 10.1016/j.amjsurg.2019.08.016. Epub 2019 Aug 21.
Incisional ventral hernias(IVH) are a common complication following open abdominal surgery. The aim of this study was to uncover the hidden costs of IVH following right-sided hepatectomy.
Outcomes and hospital billing data for patients undergoing open(ORH) and laparoscopic right-sided hepatectomies(LRH) were reviewed from 2008 to 2018.
Of 327 patients undergoing right-sided hepatectomies, 231 patients were included into two groups: ORH(n = 118) and LRH(n = 113). Median follow-up-times and time-to-hernia were 24.9-months(0.3-128.4 months) and 40.5-months(0.4-81.4 months), respectively. The incidence of hernias at 1, 3, 5, and 10 years was 6/231(2.6%), 13/231(5.6%), 15(6.5%), and 17/231(7.4%); ORH = 14, LRH = 3, p = 0.003), respectively. In terms of IVH repair(IVHR), total operative costs ($10,719.27vs.$4,441.30,p < 0.001) and overall care costs ($20,541.09vs.$7,149.21,p = 0.044) were significantly greater for patients undergoing ORH. Patients whom underwent ORHs had longer hospital stays and more complications following IVHR. Risk analysis identified ORH(RR-10.860), male gender(RR-3.558), BMI ≥30 kg/m(RR-5.157), and previous abdominal surgery(RR-6.870) as predictors for hernia development (p < 0.030).
Evaluation of pre-operative hernia risk factors and utilization of a laparoscopic approach to right-sided hepatectomy reduces incisional ventral hernia incidence and cost when repair is needed.
切口腹侧疝（IVH）是腹部开放性手术后的常见并发症。本研究旨在揭示右侧肝切除术术后 IVH 的隐性成本。
回顾 2008 年至 2018 年接受开放性（ORH）和腹腔镜右侧肝切除术（LRH）的患者的结果和住院计费数据。
在 327 例接受右侧肝切除术的患者中，有 231 例患者分为两组：ORH（n=118）和 LRH（n=113）。中位随访时间和疝发生时间分别为 24.9 个月（0.3-128.4 个月）和 40.5 个月（0.4-81.4 个月）。1、3、5 和 10 年的疝发生率分别为 6/231（2.6%）、13/231（5.6%）、15/231（6.5%）和 17/231（7.4%）；ORH=14，LRH=3，p=0.003）。就 IVH 修复（IVHR）而言，接受 ORH 的患者的总手术费用（$10719.27vs.$4441.30，p<0.001）和总体护理费用（$20541.09vs.$7149.21，p=0.044）显著更高。接受 ORH 的患者在 IVHR 后住院时间更长且并发症更多。风险分析确定 ORH（RR-10.860）、男性（RR-3.558）、BMI≥30kg/m（RR-5.157）和既往腹部手术史（RR-6.870）为疝发生的预测因素（p<0.030）。
评估术前疝危险因素并利用腹腔镜方法进行右侧肝切除术可降低切口腹侧疝的发生率和修复时的成本。
