Inpatient outcomes after elective versus nonelective ventral hernia repair

Abstract

Background: Patients who present emergently with hernia-related concerns may experience increased morbidity with repair when compared with those repaired electively. We sought to characterize the outcomes of patients who undergo elective and nonelective ventral hernia (VH) repair using a large population-based data set.

Materials and methods: The Nationwide Inpatient Sample was queried for primary International Classification of Diseases, Ninth Revision codes associated with VH repair (years 2008-2011). Outcomes were inhospital mortality and the occurrence of a preidentified complication. Multivariable analysis was performed to determine the risk factors for complications and mortality after both elective and nonelective VH repair.

Results: We identified 74,151 VH repairs performed during the study interval. Of these procedures, 67.3% were elective and 21.6% were performed laparoscopically. Nonelective repair was associated with a significantly higher rate of morbidity (22.5% versus 18.8%, P < 0.01) and mortality (1.8% versus 0.52, P < 0.01) than elective repair. Elective repairs were more likely to occur in younger patients, Caucasians, and were more likely to be performed laparoscopically. Logistic modeling revealed that female gender, Caucasian race, elective case status, and laparoscopic approach were independently associated with a lower probability of complications and mortality. Minority status and Medicaid payer status were associated with increased probability of nonelective admission.

Conclusions: Patients undergoing elective VH repair in the United States tend to be younger, Caucasian, and more likely to have a laparoscopic repair. Nonelective VH is associated with a substantial increase in morbidity and mortality. We recommend that patients consider elective repair of VHs because of the increased morbidity and mortality associated with nonelective repair.

Keywords: Elective; NIS; Nonelective; Ventral hernia.