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Effect of patient and hospital characteristics on outcomes of elective ventral hernia repair in the United States.
- Source :
-
Hernia : the journal of hernias and abdominal wall surgery [Hernia] 2013 Oct; Vol. 17 (5), pp. 639-45. Date of Electronic Publication: 2013 Apr 24. - Publication Year :
- 2013
-
Abstract
- Purposes: Our ability to predict complications of ventral hernia repairs (VHR) are inadequate. Although impact of patient comorbidities and hospital characteristics on outcomes of several surgical procedures has been reported, such analysis on elective herniorrhaphy has not been performed to date. We hypothesized that obesity and diabetes as well as socioeconomic factors would have deleterious outcomes on elective VHR.<br />Methods: Analysis of 2004-2008 Nationwide Inpatient Sample database. Main outcome measures included wound/systemic morbidity, length of stay, discharge status, and in-hospital mortality. Bivariate and multivariate analyses were performed to assess influence of diabetes, obesity, patient socioeconomic factors, and hospital characteristics on the outcomes of VHR.<br />Results: A total of 78,348 adults undergoing elective VHR were analyzed. Obesity had significant risks for cardiopulmonary complications and prolonged hospitalization. Diabetics were more likely to have delayed wound healing. Hispanic patients had significantly higher rates of pulmonary complications and mortality. As compared to private insurance patients, Medicaid and Medicare patients had significantly higher odds of complications, prolonged hospitalization, non-routine discharge, and mortality.<br />Conclusion: Obesity and diabetes appear to be significant predictors of morbidity in patients undergoing elective VHR. Alarmingly, Medicare/Medicaid patients not only had the highest rates of wound/systemic complications but also the highest post-operative mortality. For the first time, we demonstrated that in addition to comorbidities, both patient socioeconomic factors and hospital characteristics appear to be major determinants of post-herniorrhaphy complications and mortalities. Improved health maintenance and reduction in income-related disparities in health care delivery may be paramount in improving outcomes of VHR in the United States.
- Subjects :
- Adult
Comorbidity
Costs and Cost Analysis
Databases, Factual
Elective Surgical Procedures adverse effects
Elective Surgical Procedures methods
Female
Hospitals standards
Hospitals statistics & numerical data
Humans
Male
Medicare statistics & numerical data
Odds Ratio
Outcome Assessment, Health Care
Socioeconomic Factors
United States epidemiology
Diabetes Mellitus epidemiology
Hernia, Ventral economics
Hernia, Ventral epidemiology
Hernia, Ventral surgery
Herniorrhaphy adverse effects
Herniorrhaphy methods
Obesity epidemiology
Postoperative Complications classification
Postoperative Complications etiology
Postoperative Complications mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1248-9204
- Volume :
- 17
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Hernia : the journal of hernias and abdominal wall surgery
- Publication Type :
- Academic Journal
- Accession number :
- 23613017
- Full Text :
- https://doi.org/10.1007/s10029-013-1088-5