困境社区指数作为预测腹疝修补术表现和术后结果的指标。

Distressed community index as a predictor of presentation and postoperative outcomes in ventral hernia repair.

机构信息

Cleveland Clinic, General Surgery, Cleveland, USA.

出版信息

Am J Surg. 2023 Nov;226(5):580-585. doi: 10.1016/j.amjsurg.2023.06.015. Epub 2023 Jun 13.

DOI:10.1016/j.amjsurg.2023.06.015

PMID:37331908

Abstract

BACKGROUND

We evaluated the impact of socioeconomic status on presentation, management, and outcomes of ventral hernias.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

摘要

背景

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。

方法

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。

结果

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）。