Cleveland Clinic, General Surgery, Cleveland, USA.
Cleveland Clinic, General Surgery, Cleveland, USA.
Am J Surg. 2023 Nov;226(5):580-585. doi: 10.1016/j.amjsurg.2023.06.015. Epub 2023 Jun 13.
We evaluated the impact of socioeconomic status on presentation, management, and outcomes of ventral hernias.
The Abdominal Core Health Quality Collaborative was queried for adult patients undergoing ventral hernia repair. Socioeconomic quintiles were assigned using the Distressed Community Index (DCI): prosperous (0-20), comfortable (21-40), mid-tier (41-60), at-risk (61-80), and distressed (81-100). Outcomes included presenting symptoms, urgency, operative details, 30-day outcomes, and one-year hernia recurrence rates. Multivariable regression evaluated 30-day wound complications.
39,494 subjects were identified; 32,471 had zip codes (82.2%).Urgent presentation (3.6% vs. 2.3%) and contaminated cases (0.83% vs. 2.06%) were more common in the distressed group compared to the prosperous group (p < 0.001). Higher DCI correlated with readmission (distressed: 4.7% vs prosperous: 2.9%,p < 0.001) and reoperation (distressed 1.8% vs prosperous: 0.92%,p < 0.001). Wound complications were independently associated with increasing DCI (p < 0.05). Clinical recurrence rates were similar at one-year (distressed: 10.4% vs prosperous: 8.6%, p = 0.54).
Inequity exists in presentation and perioperative outcomes for ventral hernia repair and efforts should be focused on increasing access to elective surgery and improving postoperative wound care.
我们评估了社会经济地位对腹侧疝表现、治疗和结局的影响。
通过腹部核心健康质量协作组织查询接受腹侧疝修复的成年患者。使用困境社区指数（DCI）分配社会经济五分位数：繁荣（0-20）、舒适（21-40）、中层（41-60）、高危（61-80）和困境（81-100）。结果包括主要症状、紧急程度、手术细节、30 天结局和一年后疝复发率。多变量回归评估 30 天伤口并发症。
确定了 39494 名受试者；32471 人有邮政编码（82.2%）。与繁荣组相比，困境组中紧急就诊（3.6% vs. 2.3%）和污染病例（0.83% vs. 2.06%）更为常见（p<0.001）。较高的 DCI 与再入院（困境：4.7% vs. 繁荣：2.9%，p<0.001）和再次手术（困境：1.8% vs. 繁荣：0.92%，p<0.001）相关。伤口并发症与 DCI 的增加独立相关（p<0.05）。一年后临床复发率相似（困境：10.4% vs. 繁荣：8.6%，p=0.54）。
腹侧疝修复的表现和围手术期结局存在不平等现象，应努力增加选择性手术的机会，并改善术后伤口护理。
