Evidence map›Paper›PMID 33835324›Full record

ArticleHernia : the journal of hernias and abdominal wall surgery2021

The incisional hernia epidemic: evaluation of outcomes, recurrence, and expenses using the healthcare cost and utilization project (HCUP) datasets.

I A Rhemtulla, J Y Hsu, R B Broach, J T Mauch, J M Serletti, R P DeMatteo, J P Fischer

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Article in Hernia : the journal of hernias and abdominal wall surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.

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0cells of the map it votes in
16citing papers in PubMed, 1 pooled it
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1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  12. Diastasis recti is associated with incisional hernia after midline abdominal surgery.Hernia : the journal of hernias and abdominal wall surgery · 2023
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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

I A RhemtullaDivision of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
J Y HsuCenter for Clinical Epidemiology and Biostatistics (CCEB), University of Pennsylvania, Pennsylvania, PA, USA.
R B BroachDivision of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
J T MauchDivision of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.ORCID http://orcid.org/0000-0002-1590-733X
J M SerlettiDivision of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
R P DeMatteoDepartment of Surgery, University of Pennsylvania, Pennsylvania, PA, USA.
J P FischerDivision of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA. John.Fischer2@uphs.upenn.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIncisional hernias (IH) following abdominal surgery persist as morbid, costly, and multi-disciplinary surgical challenges. Using longitudinal, multi-state, administrative claims data (HCUP State Inpatient Databases (SID)); (HCUP State Ambulatory Surgery and Services Databases (SASD)), we aimed to characterize the epidemiology, outcomes, recurrence, and costs of IH. STUDY

design529,108 patients undergoing abdominal surgery in 2010 across six specialties (colorectal, general/bariatric, hepatobiliary, obstetrics/gynecology, urology, and vascular) were identified within inpatient and ambulatory databases for Florida (FL), Iowa (IA), Nebraska (NE), New York (NY), and Utah (UT). IH repairs, complications, and expenditures were assessed through 2014. Predictive regression modeling was validated using a training set of 1000 bootstrapped repetitions.

results16,169 (3.1%) patients developed hernias requiring repair (4.3-year mean follow-up), 3176 (20%) underwent recurrent repair, and 731 (23%) underwent re-recurrent repair. Patients with IH had increased readmissions (6.6 vs. 2.4), morbidity (39 vs. 8% surgical and 22 vs. 7% medical), and costs ($46,000 vs. $25,000) when compared to patients without IH (p < 0.001). IH expenditures totaled $875 million: initial ($687 million), recurrent ($155 million), and re-recurrent hernias ($33 million). IH predominated in colorectal (10%), hepatobiliary (8%), and vascular (5%) procedures. Of 31 significant independent IH risk factors (p < 0.001), obesity, age, smoking, open surgery, and prior surgery were pervasive across surgical specialties.

conclusionIH represents an unremitting surgical epidemic associated with considerable morbidity, costs, and features consistent with a chronic disease state. We define critical pervasive risk factors (obesity, age, smoking open surgery, and prior surgery) independently associated with IH across surgical disciplines. With failed repairs, subsequent success becomes less likely, increasing morbidity and costs-underscoring the critical importance of optimal treatment and prevention.

Indexed as

Colorectal NeoplasmsIncisional HerniaHealth Care CostsHerniorrhaphyHumansObesityPostoperative ComplicationsRecurrenceRetrospective StudiesCostEpidemicEpidemiologyIncisional herniaRecurrence

Identifiers

PMID33835324

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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.