Background
Ventral hernia repair (VHR), an increasingly common procedure, may have a greater
impact on health care costs than is currently appreciated. Readmissions have the potential
to further increase these costs and negatively impact patient outcomes. New national
registry data allows for an in-depth look at the predictors and rates of readmission
after VHR.
Methods
The American College of Surgeon's National Surgical Quality Improvement Program database
was queried for all patients who underwent only an incisional or VHR in 2011. Patients
who had any concomitant procedure were excluded. Using readmission as the dependent
variable, a multivariate logistic regression model was created to identify independent
predictors of readmission.
Results
VHR had a 4.9% 30-day readmission rate in 2011. Deep/incisional (12.6%) and superficial
site infections (10.5%) were the most common wound complications seen in readmitted
patients (both P < .001), whereas sepsis/septic shock (10.14%; P < .001) was the most common systemic complication. Higher class body mass index is
not associated with readmission (P = .320). Smoking and chronic obstructive pulmonary disease function as predictors
of readmission independently from their association with complications (odds ratio
[OR], 1.3; 95% confidence interval [CI], 1.1–1.6; and OR, 1.6, 95% CI, 1.1–2.3, respectively).
Operative factors such as the use of mesh (OR, 1.3; 95% CI, 0.995–1.7) or laparoscopy
(OR, 1.2; 95% CI, 0.96–1.6) do not increase likelihood of readmission.
Conclusion
There is room for improvement in VHR readmission rates. Although complications are
the main driver of readmission, surgeons must be aware of comorbidities that independently
increase the odds of readmission, even when a complication does not occur.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Nationwide Inpatient Sample. Healthcare Cost and Utilization Project (HCUP) [updated 2006]. Available at: http://www.hcup-us.ahrq.gov/nisoverview.jsp.
National Survey of Ambulatory Surgery. National Center for Health Statistics [updated 2006]. Available at: http://www.cdc.gov/nchs/nsas.htm.
- Epidemiology and cost of ventral hernia repair: making the case for hernia research.Hernia. 2012; 16: 179-183
- Surgical treatment of incisional hernia.Br J Surg. 2002; 89: 534-535
- A comparison of suture repair with mesh repair for incisional hernia.N Engl J Med. 2000; 343: 392-398
- Incisional hernia.Surg Clin North Am. 1993; 73: 557-570
- Risk factors for 30-day hospital readmission among general surgery patients.J Am Coll Surg. 2012; 215: 322-330
- Nationwide prospective study of outcomes after elective incisional hernia repair.J Am Coll Surg. 2013; 216: 217-228
The Patient Protection and Affordable Care Act. March 23, 2010.
- Report to the Congress: Promoting Greater Efficiency in Medicare.2007
- Outcomes of simultaneous laparoscopic cholecystectomy and ventral hernia repair compared to that of laparoscopic cholecystectomy alone.Surg Endosc. 2013; 27: 67-73
- Evaluation of high-risk, comorbid patients undergoing open ventral hernia repair with synthetic mesh.Surgery. 2013; 153: 120-125
- Laparoscopic versus open hernia repair: outcomes and sociodemographic utilization results from the nationwide inpatient sample.Surg Endosc. 2013; 27: 109-117
- Laparoscopic ventral hernia repair: Primary versus secondary hernias.J Surg Res. 2013; 181: e1-e5
- Long-term durability and comfort of laparoscopic ventral hernia repair.JSLS. 2012; 16: 380-386
- Laparoscopic versus open anterior abdominal wall hernia repair: 30-day morbidity and mortality using the ACS-NSQIP database.Ann Surg. 2011; 254: 641-652
- Thirty-day readmission after ventral hernia repair: predictable or preventable?.Surg Endosc. 2011; 25: 1446-1451
- Validation of new readmission data in the American College of Surgeons National Surgical Quality Improvement Program.J Am Coll Surg. 2013; 216: 420-427
- Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program.J Am Coll Surg. 2010; 210: 6-16
- Design and statistical methodology of the National Surgical Quality Improvement Program: why is it what it is?.Am J Surg. 2009; 198: S19-S27
American College of Surgeons National Surgical Quality Improvement Program. User Guide for the 2011 Participant Use Data File. Available at http://site.acsnsqip.org/wp-content/uploads/2012/03/2011-User-Guide_Final.pdf.
- Preoperative risk factors and surgical complexity are more predictive of costs than postoperative complications: a case study using the National Surgical Quality Improvement Program (NSQIP) database.Ann Surg. 2005; 242: 463-468
- Resident involvement and plastic surgery outcomes: an analysis of 10,356 patients from the American College of Surgeons National Surgical Quality Improvement Program database.Plast Reconstr Surg. 2013; 131: 763-773
- A simulation study of the number of events per variable in logistic regression analysis.J Clin Epidemiol. 1996; 49: 1373-1379
- Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors.Stat Med. 1996; 15: 361-387
- Predictive model of readmission to internal medicine wards.Eur J Int Med. 2012; 23: 451-456
- Hospital readmissions in the Medicare population.N Engl J Med. 1984; 311: 1349-1353
- Causes and implications of readmission after abdominal aortic aneurysm repair.Ann Surg. 2012; 256: 595-605
- Readmission after pancreatectomy for pancreatic cancer in Medicare patients.J Gastrointest Surg. 2009; 13: 1963-1974
- Predictors of readmission for complications of coronary artery bypass graft surgery.JAMA. 2003; 290: 773-780
- Hospitalization before and after gastric bypass surgery.JAMA. 2005; 294: 1918-1924
- Nationwide analysis of prolonged hospital stay and readmission after elective ventral hernia repair.Dan Med Bull. 2011; 58: A4322
- Nationwide study of early outcomes after incisional hernia repair.Br J Surg. 2009; 96: 1452-1457
- Abstinence from smoking reduces incisional wound infection: a randomized controlled trial.Ann Surg. 2003; 238: 1-5
- A comparative analysis between laparoscopic and open ventral hernia repair at a tertiary care center.Am Surg. 2012; 78: 888-892
- Prognosis factors in incisional hernia surgery: 25 years of experience.Hernia. 2005; 9: 16-21
- A 5-Year clinical experience with single-staged repairs of infected and contaminated abdominal wall defects utilizing biologic mesh.Ann Surg. 2013; 257: 991-996
- Outcomes of complex abdominal herniorrhaphy: experience with 106 cases.Ann Plast Surg. 2012; 68: 382-388
- Combined procedures with laparoscopic cholecystectomy.Indian J Surg. 2010; 72: 377-380
- Combined procedures in laparoscopic surgery.Surg Laparosc Endosc Percutan Tech. 2003; 13: 382-386
- Income inequality and 30 day outcomes after acute myocardial infarction, heart failure, and pneumonia: retrospective cohort study.BMJ. 2013; 346: f521
- Risk prediction models for hospital readmission: a systematic review.JAMA. 2011; 306: 1688-1698
Article info
Publication history
Published online: December 26, 2013
Accepted:
December 18,
2013
Identification
Copyright
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
