Impact of Operative Volume on Outcomes of Component Separation in Abdominal Wall Reconstruction

BackgroundComponent separation technique (CST) has emerged as a novel surgical strategy in the management of large and complex hernia defects. Although prior work has associated CST with decreased hernia recurrence and improved clinical outcomes, the impact of hospital-level variation in component separation utilization remains understudied.MethodsThis retrospective cohort study investigated the impact of operative volume on outcomes in patients undergoing CST. All adult (≥18 years) records for elective CST procedures were tabulated using the 2016-2021 Nationwide Readmissions Database. Hospitals ranked in the top quartile of annual CST volume were defined as high-volume hospitals (HVH; others LVH, MVH, and MHVH). Multivariable regression models were developed to characterize the association between HVH status and outcomes of interest.ResultsOf an estimated 12 720 patients undergoing component separation, 3359 (26.3%) underwent treatment at HVH. Although CST utilization increased significantly over the study period, the total number of high-volume centers remained relatively stable. Additionally, Medicaid recipient status, lowest income quartile, and treatment at rural hospitals were all associated with lower odds of component separation use. Following comprehensive risk adjustment, HVH status was associated with decreased odds of major adverse events (AOR [adjusted odds ratio] 0.75, 95% CI [0.61, 0.91], <i>P</i> = 0.003). However, the HVH cohort had similar resource utilization compared to their LVH, MVH, and MHVH counterparts.DiscussionHigher CST hospital volume was linked with improved clinical outcomes without increased resource utilization. Persistent disparities in component separation utilization highlight the need for protocol standardization and expanded access to specialized surgical care nationally.