Evaluation of Cost-Effectiveness of Laparoscopic Ventral and Incisional Hernia Repair Service in a District General Hospital

Background: Laparoscopic repair of ventral and incisional hernias (LRVIH) is a safe technique. This study explores the clinical and cost effectiveness of providing this service in a district general hospital.
Methods: This prospective single-centre, single-surgeon study included consecutive patients who underwent LRVIH over 6years. Demographics, surgery details and follow-up data were recorded. Costs and income were calculated from NHS payment by result (PBR) tariffs. Intergroup analysis was performed for hernia type, width class and size.
Results: 101patients with median age of 57years (interquartile range IQR 46 to 67years) and median body mass index of 32.0 kg/m2 (IQR27.7 to 35.6kg/m2) underwent repairs for 21(20.8%) primary ventral, 65(64.4%) incisional and 15(14.8%) recurrent hernias. 20(19.8%) patients had multiple abdominal wall defects at surgery. Median defect size was 25cm2 (IQR 12 to 86cm2), with epigastrium being the commonest site. Median operating time was 70minutes (IQR 60 to 110 minutes). 22(21.8%) patients had day-case surgery and overall median length of hospital stay was 1.5 bed days (IQR 1.0 to 2.0 bed days). 4(4.0%) had conversion to open procedure. 22(21.8%)
patients had complications (9 seromas, 2 haematomas, 5 respiratory complications, 7 prolonged postoperative pain) but only 2(2.0%) patients needed re-operations for adhesive small bowel obstruction. Median cost of repair was £1567.92 (IQR £1343.04 to £1991.00) and hospital income per procedure was £1747.00 (IQR £1163.00 to 2534.00), with median income of £-1.92 (IQR £-278.25 to £542.16). Laparoscopic repair was cost neutral on all intergroup analyses.
Conclusion: This study demonstrates that LRVIH is safe and cost-effective for all hernia types and sizes. Laparoscopic repair of small hernias can provide a good training opportunity for surgeons without increasing the costs.