Abstract
Background/purpose
To present a validated model that reliably predicts unplanned readmission after open ventral hernia repair (open-VHR).
Study design
A total of 17,789 open-VHR patients were identified using the 2011–2012 ACS-NSQIP databases. This cohort was subdivided into 70 and 30 % random testing and validation samples, respectively. Thirty-day unplanned readmission was defined as unexpected readmission for a postoperative occurrence related to the open-VHR procedure. Independent predictors of 30-day unplanned readmission were identified using multivariable logistic regression on the testing sample (n = 12,452 patients). Subsequently, the predictors were weighted according to β-coefficients to generate an integer-based Clinical Risk Score (CRS) predictive of readmission, which was validated using receiver operating characteristics (ROC) analysis of the validation sample (n = 5337 patients).
Results
The rate of 30-day unplanned readmission was 4.7 %. Independent risk factors included inpatient status at time of open-VHR, operation time, enterolysis, underweight, diabetes, preoperative anemia, length of stay, chronic obstructive pulmonary disease, history of bleeding disorders, hernia with gangrene, and panniculectomy (all P < 0.05). ROC analysis of the validation cohort rendered an area under the curve of 0.71, which demonstrates the accuracy of this prediction model. Predicted incidence within each 5 risk strata was statistically similar to the observed incidence in the validation sample (P = 0.18), further highlighting the accuracy of this model.
Conclusion
We present a validated risk stratification tool for unplanned readmissions following open-VHR. Future studies should determine if implementation of our CRS optimizes safety and reduces readmission rates in open-VHR patients.
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Abbreviations
- Open-VHR:
-
Open ventral hernia repair
- CRS:
-
Clinical Risk Score
- ROC:
-
Receiver operating characteristics
- AUC:
-
Area under the curve
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Disclosures
The PI for this study, Dr. Frederic E. Eckhauser, was awarded an Investigator-initiated trial grant from KCI to help fund this study. The grant contract is with Johns Hopkins University School of Medicine.
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This work was a Podium and Poster presentation at the Abdominal Wall Reconstruction Conference, June 14–16, 2014 in Washington, DC, USA. First Place Winner For Best Abstract Award.
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Baltodano, P.A., Webb-Vargas, Y., Soares, K.C. et al. A validated, risk assessment tool for predicting readmission after open ventral hernia repair. Hernia 20, 119–129 (2016). https://doi.org/10.1007/s10029-015-1413-2
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DOI: https://doi.org/10.1007/s10029-015-1413-2