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Readmissions after emergent incisional ventral hernia repair: a retrospective review of the nationwide readmissions database

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Abstract

Emergent ventral hernia repair (eVHR) is associated with significant morbidity, yet there is no consensus regarding optimal surgical approach. We hypothesized that eVHR with synthetic mesh would have a higher readmission rate compared to primary eVHR or biologic mesh repair. Retrospective analysis of the Nationwide Readmissions Database (NRD) was conducted for patient entries between 2016 and 2018. Adult patients who underwent eVHR were included. Patient demographics, comorbidities, and surgical techniques were compared between readmitted and non-readmitted patients. Predictors of readmission were assessed using multivariate analysis with propensity weighting for various eVHR techniques. Secondary outcomes included hospital length of stay and readmission diagnoses. 43,819 patients underwent eVHR; of the 22,732 with 6 months of follow-up, 6382 (28.1%) were readmitted. The majority of readmissions occurred within the first 30 days (51.8%). Over half of the readmissions were related to surgical complications (50.6%), the most common being superficial surgical site infection (30.1%) and bowel obstruction/ileus (12.2%). In the multivariate analysis, predictors of 30-day readmission included use of synthetic mesh (OR 1.07, 95% CI 1.00–1.14), biologic mesh (OR 1.26, 95% CI 1.06–1.49), and need for concomitant large bowel resection (OR 1.46, 95% CI 1.30–1.65). eVHR is associated with high rates of readmission. Primary repair had favorable odds for readmission and lower risk of surgical complications compared to synthetic and biologic mesh repairs. Synthetic repair had lower odds of readmission than biologic repair. Given the inherent limitations of the NRD, further institutional prospective studies are required to confirm these findings.

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Funding

Funding was supported by Foundation for the National Institutes of Health, UL1TR002544.

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Authors and Affiliations

  1. Department of Surgery, Tufts Medical Center, Boston, MA, USA

    Caroline A. Ricard & Jeffrey J. Aalberg

  2. Emergency Surgical Services, Department of Surgery, Tufts Medical Center, Boston, MA, USA

    Mohammed A. Bawazeer, Benjamin P. Johnson, Horacio M. Hojman, Woon Cho Kim, Eric J. Mahoney & Nikolay Bugaev

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  1. Caroline A. Ricard
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  2. Jeffrey J. Aalberg
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Contributions

CAR: study idea, literature search, study design, data analysis, data interpretation, writing, critical revision. JJA: study idea, study design, data collection, data analysis, data interpretation, writing, critical revision. MAB: data analysis, data interpretation, critical revision. BPJ: data analysis, data interpretation, critical revision. HMH: data analysis, data interpretation, critical revision. WCK: data analysis, data interpretation, critical revision. EJM: data analysis, data interpretation, critical revision. NB: study idea, literature search, study design, data interpretation, critical revision.

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Correspondence to Caroline A. Ricard.

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Conflict of interest

The authors have no financial, consultant, institutional, or ethical conflicts of interest regarding the contents of the submission.

Ethical approval

This research was conducted in compliance with ethical standards outlined by the local Institutional Review Board. This study was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, Award UL1TR002544.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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For this type of study formal consent is not required.

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@BugaevNikolay; @TuftsMedicalCtr; @TraumaJohnson.

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The STROBE Checklist for observational studies was reviewed in preparing this manuscript.

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Ricard, C.A., Aalberg, J.J., Bawazeer, M.A. et al. Readmissions after emergent incisional ventral hernia repair: a retrospective review of the nationwide readmissions database. Updates Surg 75, 1979–1989 (2023). https://doi.org/10.1007/s13304-023-01469-9

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  • DOI: https://doi.org/10.1007/s13304-023-01469-9

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