Abstract
PurposeAmbiguity exists defining abdominal wall reconstruction (AWR) and associated Current Procedural Terminology code usage in the context of ventral hernia repair (VHR), especially with recent adoption of laparoscopic and robotic-assisted AWR techniques. Current guidelines have not accounted for the spectrum of repair complexity and have relied on expert opinion. This study aimed to develop an evidence-based definition and coding algorithm for AWR based on myofascial releases performed.MethodsThree vignettes and associated outcomes were evaluated in adult patients who underwent elecive VHR with mesh between 2013 and 2020 in the Abdominal Core Health Quality Collaborative including: (1) no myofascial release (NR), (2) posterior rectus sheath myofascial release (PRS), and (3) PRS with transversus abdominis release or external oblique release (PRS-TA/EO). The primary outcome measure was operative time based on the following categories (min): 0–59, 60–119, 120–179, 180–239, and 240 + ; secondary outcomes included disease severity measures and 30-day postoperative outcomes.Results15,246 patients were included: 7287(NR), 2425(PRS), and 5534(PRS-TA/EO). Operative time increased based on myofascial releases performed: 180–239 min (p < 0.05): NR(5%), PRS(23%), PRS-TA/EO(28%) and greater than 240 min (p < 0.05): NR (4%), PRS (17%), PRS-TA/EO(44%). A dose–response effect was observed for all secondary outcome measures indicative of three distinct levels of patient complexity and outcomes for each of the three vignettes.ConclusionAWR is defined as VHR including myofascial release. Coding for AWR should reflect the actual effort used to manage these patients. We propose an evidence-based approach to AWR coding that focuses on myofascial release and is inclusive of minimally invasive techniques.
Highlights
Despite being a widely used term in ventral hernia repair (VHR), abdominal wall reconstruction (AWR) does not have a precise definition [1]
Myofascial release, in turn, has been defined in the Abdominal Core Health Quality Collaborative (ACHQC) as an abdominal wall fascial layer separated from a muscular layer since the inception of the
Given that clarification of appropriate Current Procedural Terminology (CPT) coding use is facilitated through clinical vignettes and operative time, we developed three vignettes representative of common clinical situations in VHR based on the performance of myofascial release
Summary
Despite being a widely used term in ventral hernia repair (VHR), abdominal wall reconstruction (AWR) does not have a precise definition [1]. Significant advances have been made in AWR techniques over the past 15 years, most notably the development and dissemination of various myofascial releases [2,3,4] When applied appropriately, these techniques can improve outcomes and reduce recurrence rates but are technically demanding to perform and often increase resource utilization [5, 6]. These techniques can improve outcomes and reduce recurrence rates but are technically demanding to perform and often increase resource utilization [5, 6] Advances in both laparoscopic and robotic-assisted techniques have led to a growing array of AWR options incorporating the benefits of minimally invasive surgical (MIS) approaches [7,8,9]. Myofascial release, in turn, has been defined in the ACHQC as an abdominal wall fascial layer separated from a muscular layer since the inception of the
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