Enabling Long Term Follow up After Ventral Hernia Repair Through Clinical Registry and Medicare Claims Linkage.

Abstract

<h4>Objective</h4>To evaluate the feasibility of linking short-term clinical data from a disease specific registry with longitudinal Medicare claims to improve long-term follow-up and examine hernia recurrence rates.<h4>Background</h4>Disease-specific registries provide rich perioperative data on ventral hernia repairs (VHR), but long-term follow-up remains challenging.<h4>Methods</h4>This observational cohort study linked patients in the Abdominal Core Health Quality Collaborative (ACHQC) aged≥65 or with Medicare who underwent VHR (2014-2019) to Medicare Fee-for-service claims using a sequential linkage algorithm. Follow-up duration and recurrence rates, defined as reoperation for hernia recurrence (RHR), were analyzed.<h4>Results</h4>Of 10,757 ACHQC patients, 7,418 (69%) were successfully linked to Medicare claims data. Median follow-up increased from 32 days (IQR 18-83 d) to 778 days (IQR 383-1216) (P<0.001). Linked patients had a median age of 69 years (IQR 65-74), 48% women and median BMI of 30 kg/m2 (IQR 27-35). Most underwent incisional (74%) or umbilical (18%) repair in clean (83%) situations. Mean hernia width was 5 cm (IQR 3-10) with 31% undergoing recurrent repair. Open (67%) and robotic (16%) approaches were most common. Myofascial release was performed in 39% with a fascial closure rate of 91%. Mesh was used in 88% (91% permanent synthetic mesh, 4% biologic, 4% resorbable synthetic). At 4 years, estimated RHR was 10.8%, varied by mesh type: biologic 19.3%, resorbable synthetic 16.4%, no mesh 11.1%, permanent synthetic 10.1%.<h4>Conclusion</h4>Linking clinical registry data with Medicare claims data can increase long-term follow-up after VHR and improve health services research and post market surveillance of hernia mesh.