M. J. Lee1, G. Sugiyama1, J. Nicastro1, A. Alfonso1, G. F. Coppa1, P. J. Chung2,3 1Zucker School of Medicine at Hofstra/Northwell,Department Of Surgery,New Hyde Park, NY, USA 2State University of New York Downstate Medical Center,Department Of Surgery,Brooklyn, NY, USA 3Coney Island Hospital,Department Of Surgery,Brooklyn, NY, USA
Introduction: Postoperative ileus following abdominal surgery not only causes patient discomfort but leads to increased hospital length of stay (LOS) and cost. We sought to identify risk factors associated with postoperative ileus following ventral hernia repair.
Methods: Utilizing the Nationwide Inpatient Sample (NIS) from 2008-2012, we identified adult patients that underwent either open or laparoscopic hernia repair for umbilical and ventral hernias with a diagnosis of umbilical/ventral hernia. We excluded cases with diagnosis of obstruction and bowel gangrene that underwent bowel resection, or with missing data. Risk variables of interest were age, sex, race, income status, insurance status, elective admission, comorbidity status (using the validated van Walraven Score), morbid obesity, procedure type, conversion to open, mesh use, hospital type (rural, urban non-teaching, urban teaching), bed size, and region (northeast, midwest, south, west). Univariate analysis comparing patients with ileus vs control was performed. We then performed multivariable analysis using logistic regression, adjusting for all the risk variables, with ileus as the dependent variable.
Results: 30,912 patients were identified that met criteria. Of these, 2,660 (8.61%) had postoperative ileus during their stay at the hospital. Univariate analysis showed all risk variables were associated with development of ileus with the exception of income status (p=0.2903), elective admission (p=0.7989), mesh use (p=0.3620), and hospital bed size (p=0.08351). Median length of stay was 7 days in the ileus cohort vs 3 days in control (p<0.0001). Median total charges (adjusted to 2012 dollars) was $54,819 vs $35,058 (p<0.0001). We then performed logistic regression adjusting for all risk variables and found that age (OR 1.73, p<0.0001), conversion to open (OR 1.58, p<0.0001), Black vs White race (OR 1.48, p<0.0001), male sex (OR 1.46, p<0.0001), comorbidity status (OR 1.16, p<0.0001) were independently associated with increased risk of ileus. However laparoscopic vs open (OR 0.73, p<0.0001) and northeast vs south hospital region (OR 0.74, p<0.0001) were independently associated with decreased risk of ileus.
Conclusion: We performed a large observational study looking for risk factors associated with ileus following ventral hernia repair. Race and region of treatment are independent risk factors associated with ileus following ventral hernia repair, and a potential source of disparities in care and increased admission length and higher cost of care. Further prospective studies are warranted.