2010 Annual Meeting Abstracts
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Effect of Patient and Hospital Characteristics on Outcomes of Elective Ventral Hernia Repair in the United States
*Omar Scott Antar, *Sean B Orenstein, Yuri W Novitsky
University of Connecticut Health Center, Farmington, CT
Objective: To assess the influence of patient and hospital characteristics on the outcomes of ventral hernia repair using a large national database.
Design: Multivariate logistic regression analysis of a large cohort.
Setting: The Nationwide Inpatient Sample, 2002-2006.
Patients: Adult patients who underwent elective ventral hernia repair identified using discharge ICD-9-CM codes.
Main Outcome Measures: Wound-related morbidity, cardiopulmonary complications, length of stay, discharge status, and in-hospital mortality.
Results: 78,348 undergoing elective ventral hernia repair were analyzed. Obesity had significant odds ratios of 1.28 (1.09-1.50) and 1.76 (1.47-2.10) for pulmonary complications, 1.37 (1.09-1.73) for myocardial infarction, 1.32 (1.01-1.71) for wound disruption, and 1.10 (1.46-1.17) for prolonged hospitalization. Likewise, patients with diabetes were more likely to have delayed wound healing and wound disruption (odds ratio of 1.61 and 1.33, respectively). Medicaid patients (as compared to private insurance) were more likely to have peri-operative wound complications, infections, and pulmonary complications (odds ratios of 1.50, 1.48, and 1.30, respectively). Furthermore, Medicaid patients had higher chance of prolonged length of stay, non-routine discharge, and mortality (odds ratios 1.50, 3.93, and 2.02, respectively). Private hospital status was found to have a positive effect on mortality, infection, and length of stay. All significant odds ratios for the impact of the patient and hospital variables were calculated with confidence levels of 95%.
Conclusion: Obesity and diabetes were found to be significant predictors of perioperative complications and prolonged hospitalization after ventral hernia repair. Alarmingly, Medicaid patients had significantly more frequent wound and pulmonary complications and were more likely to die following a ventral herniorrhaphy. In addition to patient comorbidities, socioeconomic factors and hospital characteristics appear to be major determinants of post-herniorrhaphy complications and mortalities.
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