Risk factors for 30-day readmission in patients undergoing ventral hernia repair

Lovecchio, Francis; Farmer, Rebecca L.; Souza, Jason M.; Khavanin, Nima; Dumanian, Gregory A.; Kim, John Yah Sung

doi:10.1016/j.surg.2013.12.021

Cited by 61 publications

(37 citation statements)

References 36 publications

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“…Although smoking is an independent risk factor for readmission and complications after IH repair, there were significantly more patients who smoked in the initial OT group. 24 This factor indicates that smoking does not contribute to the decision whether or not to operate. The majority of patients who switched from WW to OT did so during the first 24 months after diagnosis of IH.…”

Section: Discussionmentioning

confidence: 99%

Watchful waiting in incisional hernia: Is it safe?

Verhelst

Timmermans

Velde

et al. 2015

Surgery

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Section: Discussionmentioning

confidence: 99%

Watchful waiting in incisional hernia: Is it safe?

Verhelst

Timmermans

Velde

et al. 2015

Surgery

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“…Specialties represented include general surgery (15,93.8%) including minimally invasive surgery (9, 56.3%) and plastic surgery (1, 6.3%). Of these, 13 surgeons (81%) were in academic practice and three surgeons (19%) were in private practice.…”

Section: Consensus Panelmentioning

confidence: 99%

Ventral Hernia Management

et al. 2017

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Although there was consensus, supported by grade A-C evidence, on patient selection, the safety of short-term nonoperative management, and mesh reinforcement, among experts; there was limited evidence and broad variability in practice patterns in all other areas of practice. The lack of strong evidence and expert consensus on these topics has identified gaps in knowledge where there is need of further evidence.

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“…Perhaps a valuable method in the treatment of medical conditions such as hypertension, our data indicate that the approach may be misguided in this context, where big data may not adequately account for the profound effect that surgical technique may have on patient outcomes. We do not attempt to refute literature that supports a role of patient factors such as BMI, 11,17,18 smoking, 11 diet, 11 COPD, 17 kidney disease necessitating dialysis, 17 American Society of Anesthesiologists score, 17,18 incision class, 18 and blood glucose/diabetes, 11,17 which impact outcomes in hernia repair. Rather, we posit that the generalizations made by risk scores such as those evaluated here cannot be accurately made until surgical technique has been optimized.…”

Section: Discussionmentioning

confidence: 99%

Current Risk Stratification Systems Are Not Generalizable across Surgical Technique in Midline Ventral Hernia Repair

Fligor

Lanier

Dumanian

2017

Plastic and Reconstructive Surgery - Global Open

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Background:Current ventral hernia repair risk estimation tools focus on patient comorbidities with the goal of improving clinical outcomes through improved patient selection. However, their predictive value remains unproven.Methods:Outcomes of patients who underwent midline ventral hernia repair with retrorectus placement of mid-weight soft polypropylene mesh between 2010 and 2015 were retrospectively reviewed and compared with predicted wound-related complication risk from 3 tools in the literature: Carolinas Equation for Determining Associated Risk, the Ventral Hernia Working Group (VHWG) grade, and a modified VHWG grade.Results:A total of 101 patients underwent hernia repair. Mean age was 56 years and mean body mass index was 29 m/kg2 (range, 18–51 m/kg2). We found no significant relationship between the risk estimated by Carolinas Equation for Determining Associated Risk (B = 1.45, P = 0.61) and actual wound-related complications. VHWG grades >1 were not statistically different with regard to rate of wound complication compared with VHWG grade 1 (grade 2: B = 0.05, P = 0.95; grade 3: B = −0.21, P = 0.86; grade 4: B = 2.57, P = 0.10). Modified VHWG grades >1 were not statistically different with regard to rate of wound complication compared with modified VHWG grade 1 (grade 2: B = 0.20, P = 0.80; grade 3: B = 1.03, P = 0.41).Conclusions:Current risk stratification tools overemphasize patient factors, ignoring the importance of technique in minimizing complications and recurrence. We attribute our low complication rate to retrorectus placement of a narrow, macroporous polypropylene mesh with up to 45 suture fixation points for force distribution in contrast to current strategies that employ wide meshes with minimal fixation.

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Risk factors for 30-day readmission in patients undergoing ventral hernia repair

Cited by 61 publications

References 36 publications

Watchful waiting in incisional hernia: Is it safe?

Watchful waiting in incisional hernia: Is it safe?

Ventral Hernia Management

Current Risk Stratification Systems Are Not Generalizable across Surgical Technique in Midline Ventral Hernia Repair

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