C. H. Heron1, D. M. Garofalo1, Q. W. Myers1, A. Dyas1, H. Carmichael1, I. Bonner1, C. Velopulos1 1University of Colorado, School Of Medicine/Department Of Surgery, Aurora, CO, USA
Introduction:
While ventral hernias are often repaired electively in patients with access to medical care, there are many circumstances where emergent repair is required. The association between sociodemographic status and rate of emergent repair are unclear. The Social Vulnerability Index (SVI) is a measure of a patient’s living environment that may impact their ability to access care and other health resources, which is managed by the Centers for Disease Control and Prevention (CDC) and updated with every census. The purpose of this study was to investigate the association between SVI and emergent ventral hernia repair.
Methods:
This was a retrospective cohort study using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) (2012-2018) data for patients at a Level 1 Trauma Center in Denver, Colorado. Patients who had an open ventral hernia repair (Current Procedural Terminology codes 49560-49590) were included. We assigned patient SVI based on residential address at the time of surgery. We dichotomized the lower three quartiles (<75th) against the highest quartile (>75th). We conducted univariate descriptive statistics for our entire sample. We then conducted Chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables.
Results:
1017 patients met inclusion criteria. Most were men (53.4%) and white (77.9%). The median age was 50, and the median SVI score was 50, indicating that the majority of our sample were more socially vulnerable. Patients who underwent emergent operations were older (p=0.03) and had higher SVI (p=0.03). Comparing the lower three quartiles (<75th) against the highest quartile (>75th) revealed a 1.5x increase in frequency of emergency surgery (p=.047). Emergent repair was also associated with increased frequency of nonhome discharge (skilled care, rehab, hospice) (9% vs. 2%, p=.001). Finally, mean work Relative Value Unit (RVU) was significantly higher for emergent patients than non-emergent (15.4 vs. 11.9, p=<.001)
Conclusion:
Patients requiring emergency ventral hernia repair have significantly higher SVI scores than those undergoing elective repair. This vulnerable population also has increased cost associated with the repair and higher rates of nonhome discharge. This work provides a foundation for efforts to reach patients in high SVI environments at an earlier stage to achieve earlier elective repair.