Clarifications to Questions on an Incisional Hernia Cost–Benefit Study

We have read with interest the comments by Dr. Franch-Arcas and Dr. González Sánchez published in Cirugía Española¹ about our article “Cost–benefit analysis comparing laparoscopic and open ventral hernia repair”.² We would like to thank them for their interest and detailed critique. The following are our responses to the points they have indicated.

First, we should apologize as, in the Table 4, where the costs of the prostheses used were defined, the 15 cm×18 cm size appeared as “0” when this should have been €2916 and the total should have been €13 727 (Tables 4 and 7, corrected).

Table 4.

Cost of Prostheses (Mesh) Used According to Size (Corrected).

	Laparoscopy (€)	Open (€)
10×15	24 948	3451
15×18	24 440	2916
>20 cm	26 352	7360
Total	75 740	13 727

Table 5.

Cost of Disposable Surgical Material (Corrected).

	Laparoscopy (€)	Open (€)
Laparoscopic trocars	5304	0
Helical mechanical sutures	44 100	0
Mechanical sutures	1085	4620
Suction drains	0	250
Total	50 489	4870

Table 7.

Final Cost Comparison Between the 2 Techniques (Corrected).

	Laparoscopy (€)	Open (€)
Cost of prostheses (mesh)	75 740	13 727
Cost of material	50 489	4870
Cost of hospital stay	74 326	249 797
Total cost	200 555	288 687
Cost/patient	2865	4124
Reduction/patient	−1259	–

Indeed, in Table 5 the sum of the second column has been done incorrectly due to the displacement of the numbers in “suction drains” and should be €4870 (Table 5, corrected).

The authors also draw attention to the total number of hospitalization days that appear in the article (131 and 439 days). To calculate this parameter, we also included rehospitalizations for a truer calculation of costs for the entire process.

To calculate the mean hospital stay, however, rehospitalizations were not considered, although the calculation did include the sum of hours for stays shorter than 23 h, which were not considered hospitalization days as the patients did not stay overnight (24 h or 12 pm). Therefore, the result of the arithmetic operation done by the authors is different (150 and 369) and does not correlate with the analysis shown in our study.

Thus, the only difference is €100 in the sum of the cost of disposable surgical material, which changes the total open procedure cost to €288 687 and the cost/procedure to €4124, which is €1 less per patient than originally calculated (difference of €1259 vs €1260).

We again apologize for the two errors detected (“To err is human”³) and we are sorry that they were overlooked by the authors as well as the journal reviewers. Nonetheless, the resulting difference of €1 per patient in no way modifies either the philosophy or the conclusions of the article.

We are saddened by the viewpoint of these surgeons, and we would like to emphasize that, when the data of an article create confusion, the proper scientific approach would be to question the reasoning behind such differences and to request clarifications, instead of doubting the authenticity of the data presented. This is especially true when the authors are surgeons who have demonstrated their credibility and professionalism in multiple fields over the course of 30 years, with publications in international journals and prestigious articles in Cirugía Española.