麻豆传媒

In a surprise to the researchers involved, the strongest predictor for hospital readmissions after inguinal and ventral hernia repair procedures was not socioeconomic status (SES), a researcher said.

A laparoscopic approach was the strongest independent predictor of 30-day and 90-day hospital readmission rates (OR 0.646 and 0.641, respectively), though socioeconomic status was also significant (OR 1.250 and 1.229), 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 being cared for in a teaching hospital (OR 0.784 and 0.798), he said at the virtual (SAGES) meeting.

However, the majority of emergency hernia repair cases presented tended to be among lower income patients who relied on Medicaid insurance and were in the lower income quartile, Feimster added.

"This is really interesting work and I think it is super important as we start moving forward looking at these social determinants of health and how they impact the way that we care for patients," said Dana Telem, MD, MPH, of the University of Michigan in Ann Arbor.

"I think we're starting to recognize this more and more and really understand that where we live is probably more predictive of how we do, than the complexity of our disease," Telem, who was also a SAGES program chair, added at the conference.

Feimster and colleagues previously presented foundational work involving myocutaneous flap-based ventral hernia repair in association with 90-day readmission rates and determinants of health at the , which found SES disparities to be a strong predictor of readmissions. But contrary to the group's hypothesis, the strongest readmission predictor was not found to be SES, but the laparoscopic surgical approach.

From 2016 to 2017, the team used the to identify and randomize patients 1:1, based on the presence of certain ICD-10 procedural codes. Patients who had laparoscopic and open ventral and inguinal hernia repair procedures were included. The main outcomes assessed readmission rates and predictors of readmission rates at 30 and 90 days.

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 at readmission was post-operative infection. SES disparities were independently associated with poorer outcomes among patients who underwent inguinal and ventral hernia repair procedures, researchers noted.

The next steps in translating his research into action could involve multiple ways, such as "going with laparoscopic procedures as first choice," since many practices that repair inguinal hernias are offering mainly open procedures, Feimster explained.

"A lot of these [laparoscopic] procedures will help with readmissions, even touching base with a primary care physician as well and talking to them especially if they're located in that geographical area," he said.

"Telling them about the options available for hernia repair, maybe having it performed sooner rather than later or even having outreach clinics in some of these areas, especially in the areas ... [with] a rural population and maybe having outreach clinics in those areas," Feimster added.

The group noted that additional studies are needed to identify "modifiable factors," including access for elective and laparoscopic repair so surgeons can "improve outcomes in this disadvantaged population."

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