Abstract
Background
Institutions are now incentivized to decrease rates of preventable readmissions. The purpose of this study was to examine readmissions following open ventral hernia repair (VHR), to ultimately create a model to preoperatively identify high-risk patients.
Study Design
Utilizing the 2011 and 2012 ACS-NSQIP datasets, patients undergoing open VHR were identified by CPT codes. Patients who were readmitted in 2011 within 30 days of the procedure were compared to those who were not with regard to preoperative and operative characteristics. A bootstrap analysis was performed to identify internally validated risk factors to be included in the final logistic regression, which was utilized to create a weighted model to predict the risk of readmission. This model was then validated with VHR patients in 2012.
Results
Overall, 10,745 patients were included for model generation. Of these, 850 (7.9 %) patients were readmitted within 30 days. The final bootstrap analysis demonstrated that active smoking, ASA ≥ 3, a history of bleeding disorder or anemia, long operative time, inpatient status, and concurrent panniculectomy were all independently associated with readmission following ventral hernia repair. Significant variables were assigned a weighted score, ranging from 1 to 3. Each patient was then placed into one of four cohorts according to their summed score. The internally validated model [Hernia Readmission Risk (HERR) Score] demonstrated that risk increased in a linear fashion, with the highest risk cohort having a 21 % risk of 30-day readmission.
Conclusions
Perioperative predictors of readmission following VHR include smoking, ASA score, operative magnitude, concurrent panniculectomy, and preoperative anemia and bleeding disorders. The presented model based on these factors can aid in perioperative risk stratification for readmission.
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This particular research received no internal or external grant funding.
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The authors report no relevant financial disclosures related to this current work.
Ethical approval
De-identified patient information is freely available to all institutional members who comply with the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Data Use Agreement. The Data Use Agreement implements the protections afforded by the Health Insurance Portability and Accountability Act of 1996.
IRB approval
This study received IRB exemption.
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The ACS-NSQIP and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors of this study.
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Nelson, J.A., Fischer, J., Chung, C.C. et al. Readmission following ventral hernia repair: a model derived from the ACS-NSQIP datasets. Hernia 19, 125–133 (2015). https://doi.org/10.1007/s10029-014-1329-2
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DOI: https://doi.org/10.1007/s10029-014-1329-2