Effect of patient and hospital characteristics on outcomes of elective ventral hernia repair in the United States

Y. W. Novitsky, Sean Orenstein

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Purposes: Our ability to predict complications of ventral hernia repairs (VHR) are inadequate. Although impact of patient comorbidities and hospital characteristics on outcomes of several surgical procedures has been reported, such analysis on elective herniorrhaphy has not been performed to date. We hypothesized that obesity and diabetes as well as socioeconomic factors would have deleterious outcomes on elective VHR. Methods: Analysis of 2004-2008 Nationwide Inpatient Sample database. Main outcome measures included wound/systemic morbidity, length of stay, discharge status, and in-hospital mortality. Bivariate and multivariate analyses were performed to assess influence of diabetes, obesity, patient socioeconomic factors, and hospital characteristics on the outcomes of VHR. Results: A total of 78,348 adults undergoing elective VHR were analyzed. Obesity had significant risks for cardiopulmonary complications and prolonged hospitalization. Diabetics were more likely to have delayed wound healing. Hispanic patients had significantly higher rates of pulmonary complications and mortality. As compared to private insurance patients, Medicaid and Medicare patients had significantly higher odds of complications, prolonged hospitalization, non-routine discharge, and mortality. Conclusion: Obesity and diabetes appear to be significant predictors of morbidity in patients undergoing elective VHR. Alarmingly, Medicare/Medicaid patients not only had the highest rates of wound/systemic complications but also the highest post-operative mortality. For the first time, we demonstrated that in addition to comorbidities, both patient socioeconomic factors and hospital characteristics appear to be major determinants of post-herniorrhaphy complications and mortalities. Improved health maintenance and reduction in income-related disparities in health care delivery may be paramount in improving outcomes of VHR in the United States.

Original languageEnglish (US)
Pages (from-to)639-645
Number of pages7
JournalHernia
Volume17
Issue number5
DOIs
StatePublished - 2013
Externally publishedYes

Fingerprint

Ventral Hernia
Herniorrhaphy
Obesity
Mortality
Medicaid
Medicare
Comorbidity
Hospitalization
Morbidity
Wounds and Injuries
Hospital Mortality
Insurance
Hispanic Americans
Wound Healing
Inpatients
Length of Stay
Multivariate Analysis
Outcome Assessment (Health Care)
Databases
Delivery of Health Care

Keywords

  • Diabetics
  • Hernia repair
  • Obesity
  • Socioeconomic disparity

ASJC Scopus subject areas

  • Surgery

Cite this

Effect of patient and hospital characteristics on outcomes of elective ventral hernia repair in the United States. / Novitsky, Y. W.; Orenstein, Sean.

In: Hernia, Vol. 17, No. 5, 2013, p. 639-645.

Research output: Contribution to journalArticle

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