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Gender, racial, and socioeconomic disparity of preoperative optimization goals in ventral hernia repair

  • 2023 SAGES Oral
  • Published:
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Abstract

Background

Preoperative optimization cut-offs are frequently utilized to determine eligibility for elective ventral hernia repair. Our objective was to assess the relationship between gender, race, and socioeconomic status and preoperative optimization goals.

Methods

We queried our institutional database for adults with ventral hernia diagnoses between 2016 and 2021. Demographics, comorbidities, laboratory, and operative data were collected and analyzed. The following cut-offs were used to determine eligibility for elective repair: body mass index (BMI) < 40 kg/m2, no active smoking, and glycated hemoglobin (HbA1c) < 8%. Socioeconomic status was assessed using the Distressed Communities Index.

Results

A total of 5638 patients were included [Whites = 4321 (77%), Blacks = 794 (14%), Hispanics = 318 (6%), and other/unknown 205 (4%)]. Median age was 61 years and 50% were male. Most common hernia types were umbilical (36%) and incisional (20%). 10% had BMI > 40 kg/m2, 9% were active smokers and 4% had HbA1c > 8%. 21% of all patients did not meet the preoperative optimization cut-offs at time of diagnosis and those were less likely to undergo hernia repair during the study timeframe compared to those who did (OR 0.50; 95% CI [0.42–0.60]). There was a higher proportion of females (21%) and Blacks (22%) with BMI > 40 kg/m2 compared to males (11%) and other races (11–15%), p = 0.002. As the level of socioeconomic distress increased, there was a corresponding increase in the proportion of patients who did not meet preoperative optimization cut-offs from 16% in prosperous communities to 25% in distressed communities (p < 0.0001).

Conclusion

Nearly 1 of 5 patients with ventral hernias is affected by commonly used arbitrary preoperative optimization cut-offs. These cut-offs disproportionately impact females, Black patients and those with higher socioeconomic distress. These disparities need to be considered when planning preoperative optimization protocols and resource allocation to ensure equitable access to elective ventral hernia repair.

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Acknowledgements

We acknowledge the University of Florida Integrated Data Repository (IDR) and the UF Health Office of the Chief Data Officer for providing the analytic data set for this project. Additionally, the research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under the University of Florida Clinical and Translational Science Award UL1TR001427. The content of this publication, presentation, and/or proposal is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding

No funding was received for this project.

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Authors and Affiliations

  1. Department of Surgery, University of Florida, Gainesville, FL, USA

    Mazen R. Al-Mansour & Dan Neal

  2. University of Florida College of Medicine, Gainesville, FL, USA

    Khal-Hentz Gabriel

  3. Department of Surgery, University of Florida Health, PO Box 100108, Gainesville, FL, 32610-0108, USA

    Mazen R. Al-Mansour

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  1. Mazen R. Al-Mansour
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Correspondence to Mazen R. Al-Mansour.

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Disclosures

Mazen R. Al-Mansour received speaker fees from Medtronic Inc., educational support from Intuitive Surgical and general payments from W. L. Gore & Associates, Inc. Khal-Hentz Gabriel and Dan Neal have no conflicts of interest or financial ties to disclose.

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Al-Mansour, M.R., Gabriel, KH. & Neal, D. Gender, racial, and socioeconomic disparity of preoperative optimization goals in ventral hernia repair. Surg Endosc 37, 9399–9405 (2023). https://doi.org/10.1007/s00464-023-10365-7

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  • DOI: https://doi.org/10.1007/s00464-023-10365-7

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