COSTS AND OUTCOMES OF INPATIENT VERSUS OUTPATIENT HERNIA REPAIR

This study sought to compare treatment costs and outcomes for a large number of Medicare patients undergoing inpatient versus outpatient her nia repair around the country. Medicare physician and hospital claims were obtained for all Medicare enrollees residing in eleven states in 1987 and 1988, in order to take advantage of geographic variation in t reatment location. All patients undergoing uncomplicated inguinal hern ia repair were identified from the surgeon's bill; the location of sur gery was then validated by the facility bill (n = 27 036). Over one-th ird of all hernia repairs in our sample were performed on an ambulator y basis, but with tremendous variation across states, ranging from 89. 9% of cases in Washington in outpatient settings to almost none (6.3%) in Georgia. Treatment costs were 56% higher for hernias repaired on a n inpatient basis, $2341 versus $1505 for those performed in outpatien t settings. There were no detectable differences between inpatients an d outpatients along such outcomes as complication rates, deaths and he rnia recurrence, but readmission rates were higher for inpatients. The dramatic differences in costs, along with the apparent absence of adv erse outcomes, suggests that Medicare should actively encourage surgeo ns to perform more hernia repairs on an outpatient basis.