Presented at the Academic Surgical Congress 2016Predictors of emergency ventral hernia repair: Targets to improve patient access and guide patient selection for elective repair
Section snippets
Data source
We abstracted data from the 2003–2011 Nationwide Inpatient Sample (NIS), the largest publicly available source of all-payer hospital discharge abstracts in the United States. The data set is a stratified sample of discharges from 20% of participating hospitals. The hospitals are sampled to represent 95% of the US population and can be weighted to calculate national population estimates. The NIS provides information on patient and hospital factors, including International Classification of
Main results
After weighting the sample to the national population, we included 453,161 patients in the analysis (observed n = 92,295). Overall, 39.5% were “emergency” admissions (25.9% emergency, 13.6% urgent). Mean age was 57.4 years (95% confidence interval [CI]: 57.1, 57.7) in the emergency group compared with 58.3 years (95% CI: 58.0, 58.5) in the elective group (P < .001). In unadjusted analyses, the emergency group was more likely to be nonwhite, have a higher CCI, belong to a lower income quartile,
Discussion
Patients requiring emergency ventral hernia repairs had greater odds of death and concomitant bowel procedure and lesser odds of receiving a laparoscopic procedure than patients undergoing elective repairs. Total hospital cost and duration of stay were increased in patients undergoing an emergency operation. A patient's age, race/ethnicity, CCI, insurance status, hospital region, and hospital teaching status all independently predicted the need for emergency ventral hernia repair. Understanding
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Supported by the American College of Surgeons Resident Research Scholarship to L.L.W. This funding was used to support the salary of L.L.W. Not related to this work, A.H.H. is the PI of a contract (AD-1306-03980) with the Patient-Centered Outcomes Research Institute entitled Patient-Centered Approaches to Collect Sexual Orientation/Gender Identity in the ED and a Harvard Surgery Affinity Research Collaborative (ARC) Program Grant entitled Mitigating Disparities Through Enhancing Surgeons' Ability To Provide Culturally Relevant Care. A.H.H. also is the cofounder and an equity holder in Patient Doctor Technologies Inc, which owns and operates the website http://www.doctella.com.