03.20 Impact of Enterotomy(ENT) or Small Bowel Resection(SBR) on Readmission after Ventral Hernia Repair

M. Katzen1, P. Colavita1, V. Augenstein1, B. Heniford1  1Carolinas Medical Center, GI & Minimally Invasive Surgery, Charlotte, NC, USA

ENT during adhesiolysis or SBR introduces contamination which may increase the risk of perioperative complications and thus hospital readmission. Given the cost and that readmission has become a significant quality metric, the aim was to evaluate nationwide patterns and outcomes of readmissions for patients who had an ENT or SBR during open ventral hernia repair (OVHR).

The Nationwide Readmissions Database was queried between 2016-2018 for those with ICD-10-CM diagnostic code for ventral hernia and ICD-10-PCS procedure code for OVHR. Respective comparison groups were created using ICD-10 codes for ENT or SBR.


Over 3 years, 105,845 patients were admitted for OVHR. ENT occurred in 1202 (1.14% total OVHR) and 997 involved SBR (0.94% total OVHR). ENT was more common during elective procedures (1.2% elective vs 1.0% non-elective;p=<0.01) while SBR was more common during non-elective admissions (0.48%vs1.64%;p=<0.01).

Compared to OVHR without ENT or SBR, ENT and SBR groups were older (60.5 OVHR vs 62.0 ENT and 64.1 SBR; both p=<0.01). Mean Charlson Comorbidity Index was lowest in the ENT group and highest in the SBR group (1.34 vs 1.17 and 1.53;both p=<0.01). Smoking history was less common in SBR (12.5% vs 12.3% and 10.2%;p=0.83 and 0.03). Rates of diabetes were similar (24.2% vs 23.5% and 22.5%;p=0.61 and 0.21). ENT and SBR patients were less likely to be obese (31.7% vs 25.9% and 28.9%;p=<0.01 and 0.07). ENT patients had more readmission within 90 days after elective or non-elective primary admissions (elective: 16.2% OVHR vs 23.0% ENT,p=<0.01; non-elective: 19.4% OVHR vs 25.0% ENT,p=<0.01). SBR patients had the highest readmission rate but remained unchanged by elective/non-elective primary admission (26.2% vs 26.2%). ENT or SBR had longer median length of stay(LOS) (4 days OVHR vs 6 ENT and 8 SBR; both p=<0.01) and higher hospital charges ($34,790 vs $81,966 and $106,298;both p=<0.01). The most common readmission diagnosis was infection (33.0%OVHR vs 33.3%ENT and 34.8%SBR;p=0.90/0.55). ENT and SBR were more often readmitted for obstruction (7.3% vs 12.1% vs 10.7%;p=<0.01/0.04). There was no difference in reoperation for recurrence (4.9% vs 6.4% vs 3.5%;p=0.30/0.33), but ENT was more likely to have reoperation for obstruction (1.3% vs 5.3% vs 2.8%;p=<0.01 and 0.053). Logistic regression models demonstrated that ENT and SBR were independently associated with readmission (OR 1.33 ENT, 1.36 SBR).

Compared to OVHR without ENT or SBR, both ENT and SBR are associated with longer LOS, increased charges, and higher readmission rates. OVHR with ENT or SBR was associated with higher rates of readmission and reoperation for obstruction, but no difference in readmission for infection.