G. T. Rives1, W. C. Beck1, J. R. Taylor1, B. Davis1, A. Bhavaraju1, M. K. Kimbrough1, R. D. Robertson1, S. Karim2, R. J. Reif2, K. W. Sexton1 1University of Arkansas for Medical Sciences,Department Of Surgery,Little Rock, AR, USA 2University of Arkansas for Medical Sciences,College Of Public Health,Little Rock, AR, USA
Introduction:
The management strategy for non-elective admissions for incisional hernia is variable. Patients are either managed medically or surgically, a decision which is physician dependent with morbidity and symptomatology most often guiding treatment. While surgery is the more definitive treatment, there is no widely accepted guideline in the approach to treating incisional hernias. Although readmission data is lacking, it was our goal using the data available to evaluate the rate of readmission when comparing the two modalities. We hypothesized that while increasing cost, surgical management would decrease readmissions.
Methods:
The national readmission database was queried for all patients admitted with the diagnosis of incisional hernia from 2010 through Q3 2015 using ICD-9 diagnosis codes. There were 208,239 patients with non-elective admissions. Univariate and bivariate statistics were performed with JMP PRO (Cary, NC) comparing retrospective data available on the length of stay, readmission rate, Elixhauser Readmission Score, Elixhauser Mortality Score, and total costs amongst the two modes of treatment.
Results:
When comparing medical to surgical therapy, 162,473 patients were managed medically whereas 45,766 underwent surgical treatment. The average length of stay was 6.1 days and 8.5 days for medical and surgical therapy, respectively. The readmission rate was 19.3% for medical management compared to 6.6% for those managed surgically. The Elixhauser Readmission and Mortality Scores were 19.4/6.35 for medical therapy and 12.2/3.8 for surgical therapy. In regard to costs, the total cost all admissions was $68,175 for patients managed medically and $98,464 for those managed surgically. These results are summarized in Table 1. Of patients with initial medical therapy that were readmitted (31,355), 1018 (3.25%) underwent operative therapy on first readmission. An additional 4,690 eventually underwent an operation for 18.2% of the total readmitted population. Of patients with initial surgical therapy that were readmitted (n= 3,028), 52% (n=1567) underwent an operation on their first readmission.
Conclusion:
Operative management of patients admitted non-electively with incisional hernia decreases readmission rate and increases cost. Furthermore, up to 18% of patients in the medical therapy group eventually underwent operative therapy. Those patients managed medically had an average length of stay 2.4 days shorter than those managed surgically. Patients medically managed also had a higher Elixhauser Mortality Score indicating a greater degree of morbidity amongst the group. Further work needs to be done to determine the optimal management strategy of non-elective admissions for incisional hernia.
