To the surprise of the researchers involved, the best predictor of hospital readmissions after inguinal and ventral hernia repair procedures was not socioeconomic status (SES), one researcher said.
A laparoscopic approach was the strongest independent predictor of hospital readmission rates at 30 and 90 days (OR 0.646 and 0.641, respectively), although socioeconomic status was also significant (OR 1.250 and 1.229), a reported James W. Feimster, MD, of Southern Illinois University School of Medicine in Springfield.
Other independent predictors included elective admission (OR 0.824 and 0.779) and care at a teaching hospital (OR 0.784 and 0.798), he said at the virtual meeting of the American Society of Gastrointestinal Surgeons. and endoscopic (SAGES).
However, the majority of emergency hernia repair cases presented were typically for low-income patients who relied on Medicaid insurance and were in the lowest income quartile, Feimster added.
“It’s really interesting work and I think it’s super important as we start to move forward looking at these social determinants of health and how they impact the way we care for patients,” said said Dana Telem, MD, MPH, of the University of Michigan at Ann Arbor.
“I think we’re starting to recognize that more and more and really understanding that where we live is probably more predictive of what we do than the complexity of our disease,” added Telem, who was also President of the SAGES program. conference.
Feimster and colleagues previously presented seminal work on myocutaneous flap ventral hernia repair in association with 90-day readmission rates and health determinants at the 2019 SAGES Annual Conference, which found that disparities in SES were a strong predictor of readmissions. But contrary to the group’s hypothesis, the strongest predictor of readmission was not found to be SES, but the laparoscopic surgical approach.
From 2016 to 2017, the team used the National Readmissions Database to identify and randomize patients 1:1, based on the presence of certain ICD-10 procedural codes. Patients who underwent laparoscopic and open ventral and inguinal hernia repair procedures were included. Primary outcomes assessed readmission rates and predictors of 30- and 90-day readmission rates.
Overall, readmission rates were 19,429 of 208,466 patients (9.32%) at 30 days and 25,040 of 150,442 patients (16.64%) at 90 days. The most common diagnosis on readmission was postoperative infection. Disparities in SES were independently associated with poorer outcomes in patients who underwent inguinal and ventral hernia repair procedures, the researchers noted.
The next steps in translating his research into action could involve a number of ways, such as “opting for laparoscopic procedures as a first choice,” since many practices that repair inguinal hernias primarily offer open procedures, Feimster explained.
“Many of them [laparoscopic] the procedures will help with readmissions, even contacting and talking to a primary care physician as well, especially if they are in that geographic area,” he said.
“Talk to them about the options available for hernia repair, maybe getting it done as soon as possible or even having outreach clinics in some of these areas, especially in areas… [with] a rural population and maybe have outreach clinics in those areas,” Feimster added.
The group noted that further studies are needed to identify “modifiable factors”, including access to elective and laparoscopic repairs so that surgeons can “improve outcomes in this disadvantaged population”.
The authors have declared no competing interests.