To the surprise of the researchers involved, the strongest predictor of 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- and 90-day hospital readmission rates (OR 0.646 and 0.641, respectively), although socioeconomic status was also significant (OR 1.250 and 1.229), James reported. W. Feimster, MD, of the University of Southern Illinois School of Medicine at Springfield.
Other independent predictors included elective admission (OR 0.824 and 0.779) and being treated in a teaching hospital (OR 0.784 and 0.798), he told the virtual center. Society of American Gastrointestinal and Endoscopic Surgeons meeting (SAGES).
However, the majority of emergency hernia repair cases presented involved low-income patients who relied on Medicaid insurance and were in the lower income quartile, Feimster added.
“It’s really interesting work and I think it’s very important as we start to move forward looking at these social determinants of health and their impact on 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 it more and more and really understand that where we live is probably more predictive of how we do things than the complexity of our disease,” added Telem, who was also chairman of the SAGES program, conference.
Feimster and colleagues previously presented seminal work involving ventral hernia repair by myocutaneous flap in association with 90-day readmission rates and determinants of health at the time. SAGES Annual Conference 2019, which found that SES disparities were a good predictor of readmissions. But contrary to the group’s hypothesis, the strongest predictor of readmission turned out not to be SES, but the laparoscopic surgical approach.
From 2016 to 2017, the team used the National readmissions database identify and randomize patients 1: 1, based on the presence of certain ICD-10 procedure codes. Patients who had laparoscopic and open ventral and inguinal hernia repair procedures were included. The primary outcomes were readmission rates and predictors of 30- and 90-day readmission rates.
Overall, readmission rates were 19,429 of 208,466 (9.32%) at 30 days and 25,040 of 150,442 (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 multiple ways, such as “going for laparoscopic procedures as the first choice,” as many practices that repair inguinal hernias primarily offer open procedures, Feimster explained.
“Many of these [laparoscopic] The procedures will help with readmissions, even touching base with a primary care doctor and talking to them, especially if they are in that geographic area, ”he said.
“Talk to them about the options available for hernia repair, maybe have it done as soon as possible or even have outreach clinics in some of these areas, especially in the areas…” [with] a rural population and maybe have outreach clinics in those areas, ”Feimster added.
The group noted that more studies are needed to identify “modifiable factors” including access for elective and laparoscopic repair so that surgeons can “improve outcomes in this disadvantaged population.”
The authors have declared no competing interests.