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.

Keywords: Cost; Incisional hernia repair; Laparotomy closure; SNDS.

Fig. 1

Patient selection process

Fig. 2

Multivariable analysis of factors associated with the first hospitalised incisional hernia. Volume of activity of the hospital for the incisional hernia hospital stay (the annual number of abdominal surgeries of interest performed in that hospital, in quartiles). HR hazard ratio; LL lower limit of the 95% confidence internal; UP upper limit of the 95% confidence interval; COPD chronic obstructive pulmonary disease. Undergoing a laparoscopy or chronic kidney disease was not associated with incisional hernia repair (not shown on the figure)

Fig. 3

Factors associated with incisional hernia repair according to the machine learning analyses. For each field of surgery, the machine learning approach iteratively determined the strongest risk factors for incisional hernia repair and quantified the risk with relative risks (RR)