ArticleAnnals of surgery2019
Management of Reducible Ventral Hernias: Clinical Outcomes and Cost-effectiveness of Repair at Diagnosis Versus Watchful Waiting.
Article in Annals of surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 30 citations in OpenAlex.
- Laparoscopic treatment of ventral hernias: the Italian national guidelines.Updates in surgery · 2023Guideline
- Management and outcomes in acute symptomatic hernias: a retrospective cohort study and review of cross-over to surgery.Langenbeck's archives of surgery · 2026Article
- Evaluation of the effectiveness and safety of the ultralight, non-resorbable Optomesh® ULTRALIGHT surgical meshes for surgical treatment of hernias based on open and laparoscopic techniques - a retrospective analysis.Hernia : the journal of hernias and abdominal wall surgery · 2025Article
- Chronic postsurgical pain (CPSP): an underestimated problem after incisional hernia treatment.Hernia : the journal of hernias and abdominal wall surgery · 2024Article
- Operative management of non-elective incisional hernia reduces readmission in a national database.Hernia : the journal of hernias and abdominal wall surgery · 2023Article
- Short-term complications after minimally invasive retromuscular ventral hernia repair: no need for preoperative weight loss or smoking cessation?Hernia : the journal of hernias and abdominal wall surgery · 2022Article
- Chances of Mortality Are 3.5-Times Greater in Elderly Patients with Umbilical Hernia Than in Adult Patients: An Analysis of 21,242 Patients.International journal of environmental research and public health · 2022Article
- Efficacy Evaluation of a Case-Specific Approach for Surgical Treatment of Inicisional Ventral Hernia.International journal of surgery protocols · 2021Article
- Asymptomatic abdominal wall and incisional hernias: Is therapeutic decision consensual? An international survey.Annals of medicine and surgery (2012) · 2020Article
- Mesh Repair in Crohn's Disease: A Case-Matched Multicenter Study in 234 Patients.World journal of surgery · 2020Article
- What's New in the Management of Incarcerated Hernia.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
Abstract
objectiveTo compare long-term clinical and economic outcomes associated with 3 management strategies for reducible ventral hernia: repair at diagnosis (open or laparoscopic) and watchful waiting.
backgroundThere is variability in ventral hernia management. Recent data suggest watchful waiting is safe; however, long-term clinical and economic outcomes for different management strategies remain unknown.
methodsWe built a state-transition microsimulation model to forecast outcomes for individuals with reducible ventral hernia, simulating a cohort of 1 million individuals for each strategy. We derived cohort characteristics (mean age 58 years, 63% female), hospital costs, and perioperative mortality from the Nationwide Inpatient Sample (2003-2011), and additional probabilities, costs, and utilities from the literature. Outcomes included prevalence of any repair, emergent repair, and recurrence; lifetime costs; quality-adjusted life years (QALYs); and incremental cost-effectiveness ratios. We performed stochastic and probabilistic sensitivity analyses to identify parameter thresholds that affect optimal management, using a willingness-to-pay threshold of $50,000/QALY.
resultsWith watchful waiting, 39% ultimately required repair (14% emergent) and 24% recurred. Seventy per cent recurred with repair at diagnosis. Laparoscopic repair at diagnosis was cost-effective compared with open repair at diagnosis (incremental cost-effectiveness ratio $27,700/QALY). The choice of operative strategy (open vs laparoscopic) was sensitive to cost and postoperative quality of life. When perioperative mortality exceeded 5.2% or yearly recurrence exceeded 19.2%, watchful waiting became preferred.
conclusionsVentral hernia repair at diagnosis is very cost-effective. The choice between open and laparoscopic repair depends on surgical costs and postoperative quality of life. In patients with high risk of perioperative mortality or recurrence, watchful waiting is preferred.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.