A person’s socioeconomic status predicts their likelihood of readmission and complications after ventral and inguinal hernia repairs, according to the first nationwide study to examine this issue.

“Socioeconomic status will have an effect on patients’ outcomes despite the type of procedure,” said study co-author James Feimster, MD, who performed the research as chief resident at Southern Illinois University, in Springfield.

Dr. Feimster, now a MIS/bariatric fellow at Atrium Health in Charlotte, N.C., presented the study at SAGES 2021 annual meeting.

The data also suggest there is more that surgeons could do to counter the harmful effects of low socioeconomic status, he said.

Patients who had laparoscopic surgery or underwent elective repairs were readmitted at significantly lower rates—meaning surgeons may be able to improve outcomes in at-risk populations by trying to get more minimally invasive procedures to lower-income communities and operating earlier in a patient’s disease course, said Dr. Feimster.

“Increasing the amount of minimally invasive techniques as the first line for ventral and inguinal hernia repairs and improving access to patients with lower socioeconomic status, so that they can undergo elective repair, can theoretically improve overall hernia outcomes,” he said.

He and his colleagues performed a retrospective analysis of laparoscopic and open ventral and inguinal hernia repairs using the nationwide readmissions database from 2016 to 2017.

Patients were selected from the database using ICD-10 codes; 1:1 propensity score matching was conducted between patients who were readmitted and those who were not. A multivariate logistic regression analysis was performed including confounding variables like hospital setting, comorbidities, urgency of repair, socioeconomic status and payor status.

Among more than 214,000 hernia repairs with 30-day follow-up data, 24,329 patients, or 11.6%, were readmitted within one month. The most significant predictor of readmission was having open surgery; patients who received laparoscopic surgery were less likely to be readmitted, with an odds ratio of 0.65 (95% CI, 0.63-0.69).

Medicaid patients were more likely to be readmitted within 30 days, with an odds ratio of 1.25 (95% CI, 1.20-1.30). Medicaid patients were more likely to require emergent repairs compared to other patients, at 56.3% versus 49.2% (P<0.0001).

Patients who were in the bottom half of income were more likely to be readmitted than upper-income earners. Patients treated in rural hospitals, those treated in hospitals with a large bed size and patients admitted on weekends were also more likely to be readmitted.

Factors affecting 90-day readmission were similar. Overall, 17.9% of 175,253 hernia repair patients were readmitted within 90 days. Patients were less likely to be readmitted if they underwent laparoscopic surgery, and more likely if they were Medicaid patients, were among lower income earners, admitted on a weekend or for emergent surgery, or treated at rural hospitals or hospitals with a large number of beds.

Analysis showed that streptococcal sepsis and sepsis from other sources were the main diagnoses associated with readmission, indicating that wound infection was a common cause of readmission, said Dr. Feimster. However, the database provides limited information on reasons for readmission and further details were not available, he pointed out.

The study was limited by lack of detailed data, particularly patient-level information about, for instance, why patients underwent laparoscopic or open repair, or the size of the hernia defect, he said. Confounding variables were not examined in the study, including race, ethnicity, educational level and smoking status.

Commenting on the paper during the session, Dana Telem, MD, MPH, the section head of general surgery and associate chair for quality and patient safety at the University of Michigan, in Ann Arbor, said the findings illustrate the importance of social determinants of health in surgical outcomes.

“I think we’re starting to recognize this more and more, and really understanding that where we live is probably more predictive of how we do than the complexity of our disease,” she said.

Previous studies have shown that socioeconomic disparities are associated with differences in anesthesia during hernia repair, hernia recurrence rates and postoperative complications. But the association of socioeconomic status with readmission rates after hernia repair has not been well studied in the United States.