Skip to main content

Advertisement

SpringerLink
Log in

Social determinants of health and outcomes of ventral hernia repair in a safety-net hospital setting

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

Lower socioeconomic status has been shown to be predictive of poorer surgical outcomes in ventral hernia repair. Recently, safety-net hospitals have been attempting to address these disparities to improve the care of patients of lower socioeconomic status.

Methods

A query of all patients undergoing ventral hernia repair at our institution between 2010 and 2019 was completed (n = 580). Patients not from identifiable New Jersey ZIP-codes were excluded (n = 572). ZIP codes were assigned quartiles based off socioeconomic variables including median household income, percent below poverty line, and high school graduation rate. Patients were then assigned to socioeconomic status quartiles based off their residential ZIP-code. Outcomes of ventral hernia surgery were compared across ZIP-code quartiles. Logistic regression was used to analyze predictors of poor outcomes.

Results

Patients from lower socioeconomic brackets were more likely to be younger (p < 0.001), female (p = 0.014), black (p < 0.001), and/or Hispanic (p = 0.003). Most notably, outcomes of ventral hernia were not significantly different between patients of different socioeconomic status ZIP-code quartiles. The risk of any post-operative morbidity was higher for longer procedures (p < 0.001) and for hernia repairs being done with other procedures (p < 0.001). Risk of prolonged length of stay and related 30-day readmission was higher with longer procedures (p < 0.001 and p = 0.003, respectively).

Conclusion

We found that outcomes of ventral hernia repair at a safety-net hospital were unaffected by socioeconomic status. This supports the important role that safety-net institutions play in providing quality care to their vulnerable populations. Future studies at other safety-net hospitals should be done to further assess the updated impact of socioeconomic status on ventral hernia outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Khubchandani JA, Shen C, Ayturk D, Kiefe CI, Santry HP (2018) Disparities in access to emergency general surgery care in the United States. Surgery 163(2):243–250

    Article  Google Scholar 

  2. Metcalfe D, Castillo-Angeles M, Olufajo OA et al (2018) Failure to rescue and disparities in emergency general surgery. J Surg Res 231:62–68

    Article  Google Scholar 

  3. Amjad S, MacDonald I, Chambers T et al (2019) Social determinants of health and adverse maternal and birth outcomes in adolescent pregnancies: a systematic review and meta-analysis. Paediatr Perinat Epidemiol 33(1):88–99

    Article  Google Scholar 

  4. Reducing disparities in health care. American Medical Association. https://www-ama-assn-org.proxy.libraries.rutgers.edu/delivering-care/patient-support-advocacy/reducing-disparities-health-care. Accessed December, 2019

  5. NIH launches research program to reduce health disparities in surgical outcomes. National Institutes of Health. https://www.nih.gov/news-events/news-releases/nih-launches-research-program-reduce-health-disparities-surgical-outcomes. Published 2016. Accessed December, 2019

  6. Mort EA, Weissman JS, Epstein AM (1994) Physician discretion and racial variation in the use of surgical procedures. Arch Intern Med 154(7):761–767

    Article  CAS  Google Scholar 

  7. Durand MA, Yen RW, O'Malley AJ et al (2018) What matters most: protocol for a randomized controlled trial of breast cancer surgery encounter decision aids across socioeconomic strata. BMC Public Health 18(1):241

    Article  Google Scholar 

  8. Bush M (2018) Addressing the root cause: rising health care costs and social determinants of health. N C Med J 79(1):26–29

    PubMed  Google Scholar 

  9. Thornton RL, Glover CM, Cene CW, Glik DC, Henderson JA, Williams DR (2016) Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Aff (Millwood) 35(8):1416–1423

    Article  Google Scholar 

  10. Dhar VK, Kim Y, Wima K, Hoehn RS, Shah SA (2018) The importance of safety-net hospitals in emergency general surgery. J Gastrointest Surg 22(12):2064–2071

    Article  Google Scholar 

  11. Genther DJ, Gourin CG (2012) The effect of hospital safety-net burden status on short-term outcomes and cost of care after head and neck cancer surgery. Arch Otolaryngol Head Neck Surg 138(11):1015–1022

    Article  Google Scholar 

  12. Dhar VK, Hoehn RS, Kim Y et al (2018) Equivalent treatment and survival after resection of pancreatic cancer at safety-net hospitals. J Gastrointest Surg 22(1):98–106

    Article  Google Scholar 

  13. Io M (2000) America's health care safety net: intact but endangered. The National Academies Press, Washington

    Google Scholar 

  14. Won RP, Friedlander S, Lee SL (2017) Outcomes and costs of managing appendicitis at safety-net hospitals. JAMA Surg 152(11):1001–1006

    Article  Google Scholar 

  15. Hoehn RS, Wima K, Vestal MA et al (2016) Effect of hospital safety-net burden on cost and outcomes after surgery. JAMA Surg 151(2):120–128

    Article  Google Scholar 

  16. Herrel LA, Wong SL, Ye Z, Miller DC (2016) Utilization and outcomes of inpatient surgery at safety-net hospitals. J Health Care Poor Underserv 27(4):1872–1884

    Article  Google Scholar 

  17. Nguyen MT, Berger RL, Hicks SC et al (2014) Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy: a systematic review and meta-analysis. JAMA Surg 149(5):415–421

    Article  Google Scholar 

  18. Lovecchio F, Farmer R, Souza J, Khavanin N, Dumanian GA, Kim JY (2014) Risk factors for 30-day readmission in patients undergoing ventral hernia repair. Surgery 155(4):702–710

    Article  Google Scholar 

  19. Baucom RB, Ousley J, Beveridge GB et al (2016) Cancer Survivorship: defining the incidence of incisional hernia after resection for intra-abdominal malignancy. Ann Surg Oncol 23(Suppl 5):764–771

    Article  Google Scholar 

  20. Bowman K, Telem DA, Hernandez-Rosa J, Stein N, Williams R, Divino CM (2010) Impact of race and socioeconomic status on presentation and management of ventral hernias. Arch Surg 145(8):776–780

    Article  Google Scholar 

  21. Community Facts. United States Census Bureau. https://factfinder.census.gov/. Published 2019. Accessed November, 2019

  22. Agarwal S, Menon V, Jaber WA (2015) Outcomes after acute ischemic stroke in the United States: does residential ZIP code matter? J Am Heart Assoc 4(3):e001629

    Article  Google Scholar 

  23. Chatterjee P, Joynt KE, Orav EJ, Jha AK (2012) Patient experience in safety-net hospitals: implications for improving care and value-based purchasing. Arch Intern Med 172(16):1204–1210

    Article  Google Scholar 

  24. Birkmeyer NJ, Gu N, Baser O, Morris AM, Birkmeyer JD (2008) Socioeconomic status and surgical mortality in the elderly. Med Care 46(9):893–899

    Article  Google Scholar 

  25. Fiscella K, Franks P, Meldrum S, Barnett S (2005) Racial disparity in surgical complications in New York State. Ann Surg 242(2):151–155

    Article  Google Scholar 

  26. Askew G, Williams GT, Brown SC (1992) Delay in presentation and misdiagnosis of strangulated hernia: prospective study. J R Coll Surg Edinb 37(1):37–38

    CAS  PubMed  Google Scholar 

  27. Gittelsohn AM, Halpern J, Sanchez RL (1991) Income, race, and surgery in Maryland. Am J Public Health 81(11):1435–1441

    Article  CAS  Google Scholar 

  28. Black-white disparities in health care. JAMA 1990;263(17):2344-2346

  29. Weissman JS, Stern R, Fielding SL, Epstein AM (1991) Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med 114(4):325–331

    Article  CAS  Google Scholar 

  30. National Health Expenditure Projections 2018–2027. Centers for Medicaid & Medicare Services. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ForecastSummary.pdf. Accessed December, 2019

Download references

Funding

There was no funding for this research.

Author information

Authors and Affiliations

  1. Department of Surgery, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Science, 185 South Orange Avenue, MSB G530, Newark, NJ, 07103, USA

    A. Gupta, J. B. Cadwell & A. M. Merchant

Authors
  1. A. Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. B. Cadwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. M. Merchant
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concepts: All authors. Study design: All authors. Data acquisition: AG. Quality control of data and algorithms: All authors. Data analysis and interpretation: JC. Statistical analysis: JC. Manuscript preparation: All authors. Manuscript editing: All authors. Manuscript review and approval: All authors. All authors contributed equally to all aspects of the research and manuscript construction.

Corresponding author

Correspondence to A. M. Merchant.

Ethics declarations

Conflict of interest

Amit Gupta, Joshua B. Cadwell, and Aziz M. Merchant MD declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institute and regional research committee and with the 1964 Helsinki declaration and its later amendments of comparable ethical standards.

Human and animal rights

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

Informed consent

For this study formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gupta, A., Cadwell, J.B. & Merchant, A.M. Social determinants of health and outcomes of ventral hernia repair in a safety-net hospital setting. Hernia 25, 287–293 (2021). https://doi.org/10.1007/s10029-020-02203-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-020-02203-9

Keywords

Search

Navigation