Ventral hernia: retrospective cost analysis of primary repair, repair with synthetic mesh, and repair with acellular xenograft implant

George DeNoto III,¹ Nancy Reaven,² Susan Funk<sup>2

1</sup>Division of General Surgery, St Francis Hospital, Roslyn, and Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA; ²Strategic Health Resources, La Cañada, CA, USA

Background: The purpose of this study was to evaluate resource utilization and costs of repair of potentially contaminated/infected complex ventral hernias using primary repair, synthetic mesh, or acellular xenograft.
Methods: We used 2008–2009 insurance claims (Truven Health Analytics MarketScan^®) to identify patients who underwent grade 3 or 4 ventral hernia repair between January 1 and June 30, 2008. Patients were categorized into synthetic mesh or xenograft groups based on Current Procedural Terminology and Healthcare Common Procedure Coding System codes, with primary repair identified by the absence of mesh or xenograft codes. Claims were reviewed for an 18-month post-procedure period to identify the incidence of medical complications, number of post-index events, and hospital costs.
Results: A total of 740 patients were included. Complication rates in grade 3 patients were significantly lower with xenograft (18%) and primary repair (24%) versus synthetic mesh (37%, P = 0.001). There were minimal differences between grade 4 patients. In grade 3 patients, synthetic mesh was associated with hospital returns for complications about three times as often as those with xenograft repairs and significantly more often than those with primary repairs (P < 0.0001). The average treatment cost for a xenograft repair in grade 3 patients was $33,266 versus a primary repair at $34,948 and synthetic mesh at $35,891 (difference not statistically significant). In grade 4 patients, there was no statistically significant difference between the study arms in the rate of returns for treatment of complications or costs.
Conclusion: In this analysis of grade 3 and 4 hernia repair, total 18-month costs were similar across the three study arms despite some significant differences in complications favoring xenograft and primary repair over synthetic mesh.

Keywords: synthetic mesh, acellular xenograft, ventral hernia, cost analysis