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P602 Secondary healthcare use following major abdominal surgery employing an acellular reconstructive tissue matrix

S. Das Mohapatra1, J. O'Hara*2, 3, C. Camp2, D. Hughes2, 3, A.C.J. Windsor1

1University College London Hospital, Colorectal Service, London, United Kingdom, 2Healthcare Decisions, Ltd., Daresbury, United Kingdom, 3University of Chester, Faculty of Health and Social Care, Chester, United Kingdom

Background

An analysis of pre- and post-intervention secondary healthcare use for major reconstructive surgeries involving the use of Strattice™ Reconstructive Tissue Matrix (TM), an acellular porcine dermal matrix.

Methods

A before-after analysis of secondary healthcare use was conducted for 154 major abdominal surgeries undertaken at University College London Hospitals Trust (UK) between February 2010 and October 2013. All interventions employed Strattice™ TM. Pre- and post-intervention pathways (inpatient (IP), outpatient (OP), and Accident & Emergency (A&E)) were quantified using Hospital Episode Statistics covering NHS hospitals in England (data April 2008 - December 2013). Non-parametric t-tests were used to assess for significance.

Results

Mean age at intervention was 57.5 years (SD 12.9). 54% of surgery recipients were female. Three-quarters of interventions occurred as part of an elective admission. The most common primary diagnosis at intervention was ventral hernia (31%), followed by intestinal fistula (15%). Interventions were primarily for incisional hernia repair (36%). A total of 11,798 pre- and post-intervention observations were recorded in the sample period. An average of 3.4 years' worth of data was available pre-intervention; average follow-up was 2.4 years.

IP admissions decreased between pre- and post-intervention periods (mean 2.0; SD 12.7; p<0.001), representing a reduction in bed-days (BD) and excess BD of 31.0 (SD 104.6; p<0.001) and 15.0 (73.4; 0.002) respectively. OP appointments post-intervention decreased by an average of 10.6 (42.2; 0.001). No significant impact on A&E attendances was observed (mean 0.6; SD 9.3; p=0.26).

In order to balance the pre- and post-intervention observation windows, an analysis of 12-month resource use was conducted on pathways for individuals with 12 months of data pre- and post-intervention (window of analysis: 720 days; observations n=4,367; interventions n=129). Excess BD decreased by mean 12.3 (SD 48.0; p=0.01). IP admissions and BD decreased, although neither result was significant ((mean reduction; SD; p-value) (0.5; 5.2; 0.19) and (20.4; 57.4; 0.25), respectively). A&E attendances increased, again insignificantly (mean 0.4; SD 2.4; p=0.5). OP appointments decreased significantly, albeit marginally (mean -0.01; SD 15.5; p=0.02).

Conclusion

This is the first work in a larger study intended to assess the effectiveness of Strattice™ TM in 'real-world' major surgery. The sample exhibits substantial clinical heterogeneity, which may limit the interpretability and generalisability of the results. However, the results of this work support the proposition that abdominal surgeries employing biological mesh result in decreased secondary healthcare use.