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Determinants of 90-day readmission following ventral hernia repair with and without myocutaneous flap reconstruction

James W Feimster, MD, Sabha Ganai, MD, PhD, MPH, Steve Scaife, PhD, John D Mellinger, MD. Southern Illinois University School of Medicine

Introduction: Readmission status is an important clinical and economic component of healthcare outcomes.  Readmission following ventral hernia repair has not been well-studied with national level data.  This study aims to compare readmission rates for patients undergoing standard vs. complex (myocutaneous flap-based) ventral hernia repair.  We hypothesize that complexity of reconstruction will be an independent predictor of readmission after ventral hernia repair.

Methods: A retrospective cohort study was performed with 1:1 matching of hernia repair type using the National Readmissions Database (2013-2014). Patients were selected using ICD-9 codes corresponding to ventral hernia repair with or without myocutaneous flap utilization. 90-day readmissions were determined on patients within the 1st-3rd quarters of each year so complete follow-up data was available. Mortalities during index admission were excluded. After matching, a logistic regression analysis was performed using confounding variables including hospital setting, key comorbidities, urgency of repair, sociodemographic status, and payor. Likelihood of 90-day readmission was reported in odds ratio form, and P-values were considered significant if less than 0.05.

Results: Readmission rates were 19.13% (38,313 out of 200,266) and 22.52% (692 out of 3073) at 90-days for standard ventral hernia repair and complex ventral hernia repair, respectively. 3,116 standard ventral hernia repair patients were matched with 3,074 complex ventral hernia repair patients. After matching for sociodemographic features, comorbidities, and hospital characteristics, there was a significantly increased readmission rate for repairs involving myocutaneous flaps, with odds ratio 1.298 (95% CI, 1.219-1.604). Payor status (OR 1.824; 95% CI, 1.214-2.739), teaching hospital status (OR 1.416; 95% CI 1.225-1.638) and income quartile (OR 1.348; CI, 1.100-1.651) were independent predictors of readmission on logistic regression analysis.

Conclusion: The data support our hypothesis that patients undergoing myocutaneous flap-based reconstruction have higher readmission rates than those undergoing less complex ventral hernia repair.  Socioeconomic disparity as reflected in payor status is a particularly strong predictor of readmission in this patient population. The data supports the concept that focused efforts are needed to optimize patient outcomes for patients requiring more complex repair, as well as for socioeconomically disadvantaged patient populations.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95537

Program Number: S031

Presentation Session: Complex Abdominal Wall Hernia

Presentation Type: Podium

85

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