Hoffman Ryan D, Danos Denise M, Lau Frank H
Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA.
Department of Behavioral and Community Health, Louisiana State University Health Sciences Center, New Orleans, LA.
Surgery. 2021 Jun;169(6):1393-1399. doi: 10.1016/j.surg.2020.11.028. Epub 2021 Jan 6.
Incisional hernias represent an acquired defect from failed healing of an abdominal facial incision and are therefore distinct from primary hernias. While literature regarding incisional hernia incidence, risk factors, and treatment are abundant, no study has examined national health disparities specific to incisional hernia repair. The objective of this study was to analyze national health disparities unique to surgical incisional hernia repair procedures.
Patient data queried from the Healthcare Cost and Utilization Project National Inpatient Sample from 2012 to 2014 using International Classification of Diseases 9th revision procedure codes for incisional hernia repair were used to generate univariate and multivariate models including demographics, socioeconomic factors, admission status, and hospital characteristics. Primary outcomes were nonelective admission status, in-hospital mortality, surgical complications, and extended duration of stay.
We estimated that 89,258 incisional hernia repair procedures occurred annually from 2012 to 2014, incurring $6.3 billion in hospital charges. By multivariate analysis, multiple risk factors contribute to significantly increased odds of nonelective repair. These include age over 65, female sex, non-White race, nonprivate insurance, obesity, and increased Charlson comorbidity index. Nonelective incisional hernia repair was strongly correlated with worse outcomes including in-hospital mortality (odds ratio [95% confidence interval] 3.01 [2.51, 3.61]), postoperative complications (odds ratio 1.2 [1.14, 1.25]), and extended duration of stay (odds ratio 2.96 [2.81, 3.12]). After controlling for admission status, other disparities persisted including extended duration of stay for Black individuals (odds ratio 1.21 (1.12, 1.31]).
Providers should be aware of these significant health disparities in incisional hernia repair status and outcomes especially for elderly, non-White, nonprivate insurance, and obese/comorbid patients. Management strategies that increase access to elective repair and that prevent incisional hernia should be expanded to address these disparities.
切口疝是腹部切口愈合失败导致的后天性缺损，因此与原发性疝不同。虽然关于切口疝发病率、危险因素和治疗的文献很多，但尚无研究探讨切口疝修补术特有的全国性健康差异。本研究的目的是分析手术切口疝修补术特有的全国性健康差异。
使用国际疾病分类第九版切口疝修补术程序编码，从2012年至2014年医疗保健成本和利用项目国家住院样本中查询患者数据，以生成单变量和多变量模型，包括人口统计学、社会经济因素、入院状态和医院特征。主要结局为非择期入院状态、住院死亡率、手术并发症和延长住院时间。
我们估计，2012年至2014年每年进行89,258例切口疝修补术，产生63亿美元的医院费用。通过多变量分析，多种危险因素导致非择期修补的几率显著增加。这些因素包括65岁以上、女性、非白人种族、非私人保险、肥胖以及查尔森合并症指数增加。非择期切口疝修补与更差的结局密切相关，包括住院死亡率（比值比[95%置信区间]3.01[2.51, 3.61]）、术后并发症（比值比1.2[1.14, 1.25]）和延长住院时间（比值比2.96[2.81, 3.12]）。在控制入院状态后，其他差异仍然存在，包括黑人患者延长住院时间（比值比1.21[1.12, 1.31]）。
医疗服务提供者应意识到切口疝修补状态和结局方面的这些显著健康差异，尤其是对于老年、非白人、非私人保险以及肥胖/合并症患者。应扩大增加择期修补机会和预防切口疝的管理策略，以解决这些差异。
