Andrew T Bates, MD, Jie Yang, PhD, Maria Altieri, Chencan Zhu, BS, Salvatore Docimo, Jr., DO, Konstantinos Spaniolas, MD, Aurora Pryor, MD. Stony Brook University Hospital
Introduction: Patients with symptomatic inguinal and umbilical hernias often present to the emergency department (ED) when their symptoms change or increase, usually not requiring emergent surgery. However, little is known about how often these patients present prior to eventual repair and whether they undergo surgery at the initial presenting institution. The aim of this study was to assess the clinical flow of patients presenting in the ED for inguinal and umbilical hernia.
Methods: All patients presenting to EDs in New York State from 2005 to 2014 with symptomatic inguinal and umbilical hernias were identified using the New York State longitudinal hospital claims database (SPARCS). Patients were followed for records of hernia repair and subsequent inpatient and outpatient visits up to 2014.
Results: 42,950 patients presenting to the ED for symptomatic inguinal hernia were identified. 5.3% (2,297) of ED presentations resulted in inpatient admissions. 14,491 (33.7%) had repair later and their average time from ED presentation to inguinal hernia repair was 158(±351) days. 90.1% of patients who did not have subsequent surgery had only one ED visit. Of those that underwent interval repair, 79.7% had only one ED visit prior to surgery. For those patients with only one ED visit before repair, 29.3% had repair at a different hospital, as opposed to 48.6% if multiple ED visits were made. 15,297 umbilical hernia patients presenting to the ED were identified. 7.2% (1,109) resulted in inpatient admission. 3,507 (22.9%) had interval repair, with the average time from ED presentation to umbilical hernia repair being 175(±369.82) days. 92% of patients who did not record of later repair presented to the ED once. Of those patients who underwent repair, 78.5% did so after one ED visit. For those patients with only one ED visit before repair, 32.9% had repair at a different hospital, as opposed to 48.6% if multiple ED visits were made.
Conclusion: A majority of patients with symptomatic inguinal and umbilical hernias that present to the ED do so once with no subsequent follow-up or repair. For those patients that undergo interval repair, a significant portion willnopt for surgery at other hospitals. A significant proportion of patients with acutely symptomatic inguinal/umbilical hernias who undergo interval repair after a previous ED visit, will opt for definitive surgery at another hospital facility. This represents a missed opportunity for continuity of care for providers and healthcare systems.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87887
Program Number: P073
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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