One-Year Health Care Utilization and Recurrence After Incisional Hernia Repair in the United States: A Population-Based Study Using the Nationwide Readmission Database

Rios-Diaz, Arturo J.; Cunning, Jessica R.; Broach, Robyn B.; Metcalfe, David; Elfanagely, Omar; Serletti, Joseph M.; Palazzo, Francesco; Fischer, John P.

doi:10.1016/j.jss.2020.03.070

Cited by 16 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Adverse outcomes have a lasting impact on patients’ physical and mental health, which often leads to hernia recurrence, prolonged healing, and impaired QoL and ability to return to work 25 , leading to wider-reaching socioeconomic implications. A US readmission database study 27 reported that around one-fifth of patients undergoing ventral hernia repair are readmitted within 1 year, and 35 per cent of these require reoperation. Reducing the risks of surgery for each patient has to be central in any decision-making.…”

Section: Discussionmentioning

confidence: 99%

Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement

et al. 2021

View full text Add to dashboard Cite

Background The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20–41 per cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe. Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection, management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide a clear benchmark of care for the preoperative assessment and perioperative optimization of patients undergoing AWR. Methods The Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirty-two hernia surgeons from recognized hernia societies globally took part. The process included two rounds of anonymous web-based voting with response analysis and formal feedback, concluding with a live round of voting followed by discussion at an international conference. Consensus for a strong recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per cent agreement. Results Consensus was obtained on 52 statements including surgical assessment, preoperative assessment, perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment. Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement. Conclusion Clear consensus recommendations from a global group of experts in the AWR field are presented in this study. These should be used as a baseline for surgeons and centres managing abdominal wall hernias and performing complex AWR.

show abstract

Section: Discussionmentioning

confidence: 99%

Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Furthermore, researchers can only track readmissions within a given calendar year, as unique patient identifiers within the database change from year to year. Researchers have used the NRD to evaluate costs following procedures, such as incisional hernia repair and surgical stabilization of rib fractures, to compare costs and readmissions after laparoscopic versus robotic versus open hepatectomy, to evaluate the longer-term economic burden of readmissions after trauma-associated venous thromboembolism, as well as the costs associated with potentially preventable readmissions after surgery 65–69 …”

Section: Surgically Relevant Databases With Economic Outcomesmentioning

confidence: 99%

“…Researchers have used the NRD to evaluate costs following procedures, such as incisional hernia repair and surgical stabilization of rib fractures, to compare costs and readmissions after laparoscopic versus robotic versus open hepatectomy, to evaluate the longer-term economic burden of readmissions after trauma-associated venous thromboembolism, as well as the costs associated with potentially preventable readmissions after surgery. [65][66][67][68][69] Kid's Inpatient Database The Kid's Inpatient Database (KID) is the largest publicly available all-payer pediatric inpatient discharge database in the United States, with data weighted to estimate inpatient utilization, access, charges, quality, and outcomes for 7 million hospitalizations each year. Of note, the KID is only produced by HCUP every 3 years, with the most recent data available from 2016.…”

Section: Nationwide Readmission Databasementioning

confidence: 99%

Data resources for evaluating the economic and financial consequences of surgical care in the United States

Scott

Ayoung-Chee

Lester

et al. 2022

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Operative factors included procedure category or categories (esophagogastric, small bowel and/or large bowel, ostomy, hepatopancreaticobiliary, obstetrics/gynecology, urology, endocrine, or vascular), as defined by ICD-9 procedure codes described in a prior study. 26 Postoperative factors included surgical and nonsurgical complications (as described elsewhere 31 ), a prolonged length of stay (>75th percentile), and the number of abdominal reoperations during the index admission and postdischarge.…”

Section: Data Source and Covariatesmentioning

confidence: 99%

Incidence, Burden on the Health Care System, and Factors Associated With Incisional Hernia After Trauma Laparotomy

et al. 2021

Self Cite

View full text Add to dashboard Cite

IMPORTANCEThe evidence provided supports routine and systematic capture of long-term outcomes after trauma, lengthening the follow-up for patients at risk for incisional hernia (IH) after trauma laparotomy (TL), counseling on the risk of IH during the postdischarge period, and consideration of preventive strategies before future abdominal operations to lessen IH prevalence as well as the patient and health care burden.OBJECTIVE To determine burden of and factors associated with IH formation following TL at a population-based level across health care settings. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included adult patients who were admitted with traumatic injuries and underwent laparotomy with follow-up of 2 or more years. The study used 18 statewide databases containing data collected from January 2006 through December 2016 and corresponding to 6 states in diverse regions of the US. Longitudinal outcomes were identified within the Statewide Inpatient, Ambulatory, and Emergency Department Databases. Patients admitted with International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for traumatic injuries with 1 or more concurrent open abdominal operations were included. Data analysis was conducted from March 2020 through June 2020. MAIN OUTCOMES AND MEASURES The primary outcome was IH after TL. Risk-adjusted Cox regression allowed identification of patient-level, operative, and postoperative factors associated with IH. RESULTS Of 35 666 patients undergoing TL, 3127 (8.8%) developed IH (median [interquartile range] follow-up, 5.6 [3.4-8.6] years). Patients had a median age of 49 (interquartile range, 31-67) years, and most were male (21 014 [58.9%]), White (21 584 [60.5%]), and admitted for nonpenetrating trauma (28 909 [81.1%]). The 10-year IH rate and annual incidence were 11.1% (95% CI, 10.7%-11.5%) and 15.6 (95% CI, 15.1-16.2) cases per 1000 people, respectively. Within risk-adjusted analyses, reoperation (adjusted hazard ratio [aHR], 1.28 [95% CI, 1.2-1.37]) and subsequent abdominal surgeries (aHR, 1.71 [95% CI,), as well as obesity (aHR, 1.88 [95% CI, 1.69-2.10]), intestinal procedures (aHR, 1.47 [95% CI, 1.36-1.59]), and public insurance (aHRs: Medicare, 1.38 [95% CI, 1.20-1.57]; Medicaid, 1.35 [95% CI, 1.21-1.51]) were among the variables most strongly associated with IH. Every additional reoperation at the index admission and subsequently resulted in a 28% (95% CI, 20%-37%) and 71% (95% CI, 56%-88%) increased risk for IH, respectively. Repair of IH represented an additional $36.1 million in aggregate costs (39.9%) relative to all index TL admissions.CONCLUSIONS AND RELEVANCE Incisional hernia after TL mirrors the epidemiology and patient profile characteristics seen in the elective setting. We identified patient-level, perioperative, and novel postoperative factors associated with IH, with obesity, intestinal procedures, and repeated disruption of the abdominal wall among the factors most strongly associated with this outcome. These data suppo...

show abstract

One-Year Health Care Utilization and Recurrence After Incisional Hernia Repair in the United States: A Population-Based Study Using the Nationwide Readmission Database

Cited by 16 publications

References 23 publications

Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement

Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement

Data resources for evaluating the economic and financial consequences of surgical care in the United States

Incidence, Burden on the Health Care System, and Factors Associated With Incisional Hernia After Trauma Laparotomy

Contact Info

Product

Resources

About