Ventral Hernia Repair’s Added Cost of Infection

A simple hernia repair surgery. Most doctors sell it as a walk in the park depending on the hernia and certainly the standard of care is to use surgical mesh. But a new study from the American College of Surgeons (ACS) finds the simple surgery for ventral hernia repair can bring a $100,000 price tag if the site becomes infected. Compare that to a hernia repair without complications where the cost hovers around $38,000.Costs go up when the patient is subject to repeat operations, the possibility of a replacement mesh, hospitalizations, clinic visits and imaging – all can raise the price tag to about $107,000.

Unfortunately for a ventral hernia repair, which results from a defect or incision in the abdominal wall, the risk of infection will affect up to two-thirds of these patients. A previous hernia repair increases the risk factor for an infection as does an active infection and the size of the mesh needed to cover the defect.

This picture shows a diagram of a hiatal hernia.

The goal has been to bring down those numbers by choosing the right repair material.

The December issue of the Journal of the American College of Surgeons found lightweight polypropylene mesh performed well in a contaminated ventral hernia repair. This study says when compared to biologic mesh, the patients who received synthetic mesh had fewer wound infections (13.5 to 46.2 percent) but had a higher number of mesh infections (2.6 to 0%).

Biologic mesh is about twenty times more expensive than polypropylene, a petroleum-based plastic used for surgical mesh. The use of synthetics declined in the late 90s because of surgical site infections, adhesions and fistulas in an open abdominal reconstruction.

The four authors (who are also listed as consultants for major synthetic mesh manufacturers), propose a lightweight polypropylene mesh, even when placed in a potentially contaminated field may yield infection rates lower than for biologic mesh. The article is considered a paradigm shift in managing abdominal hernia repairs in contaminated or clean-contaminated fields. Unfortunately when the authors are obligated to industry in some way, it is difficult to determine whether the conflict of interest may be affecting their conclusions.

Unlike the warning for transvaginal mesh placed in women to treat prolapse or incontinence, there has been no warning for hernia mesh, even though it is made from the same material. The Food and Drug Administration has taken in reports of pain, infection, recurrence, adhesions, obstruction and perforation. A bowel perforation can lead to sepsis or a poisoning of the bloodstream and is potentially fatal if not treated.

The costs related to such infections tops $3 billion annually according to a study published in the New England Journal of Medicine in 2004.

Doctors need to understand the costs to patients of common outcomes to keep the cost of a complication down for the patient and for the system as a whole. It is simply good patient care to want to minimize complications, no matter who is funding a study.