A. K. Hallway1,6, S. Dualeh1,6, J. Sinamo1,6, D. Sukhon5,6, A. Ehlers1,4, D. Telem1,3,6, M. Rubyan2 1University Of Michigan, Department Of Surgery, Ann Arbor, MI, USA 2University Of Michigan, School Of Public Health, Ann Arbor, MI, USA 3University Of Michigan, Medical School, Ann Arbor, MI, USA 4Veterans Affairs Ann Arbor Health Care, Ann Arbor, MI, USA 5Oakland University William Beaumont, School Of Medicine, Royal Oak, MI, USA 6University Of Michigan, Center For Healthcare Outcomes And Policy (CHOP), Ann Arbor, MI, USA
Introduction: Emergency surgery is costly and morbid. At a population level, there is a dearth of information understanding surgeon practice patterns and patient outcomes. In this context, we characterize the patients, practices, and clinically nuanced hernia characteristics associated with eVHR and their outcomes in a statewide population.
Methods: All adult patients in the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC COHR) were included in this study. The registry is a representative, random sample of adult patients from 70 Hospitals across the state of Michigan and it encompasses surgeries performed between Jan 1, 2020 to March 31, 2023. Operations classified as urgent or emergent were grouped into an emergency category and compared to elective cases via univariate analysis. Multivariate logistic regression was employed to evaluate the independent association of patient, hernia, and operative characteristics with the composite occurrence of any 30-day complication following eVHR only. Covariates included in the logistic regression model included patient demographics, patient comorbidities, and hernia/operative characteristics.
Results: 10,000 people were included in this retrospective cohort study. 9,193 operations were classified as elective and 807 were emergent. Compared to people receiving elective repair, those receiving eVHR were older (median[IQR] age 59 [47-70] vs 55 [43-65], p < .001) and a greater proportion were female (58% vs 43%, p < .001) and black (18% vs 12%, p < .001). A greater proportion of eVHR patients were insured by Medicaid (40% vs 25%, p < .001) rather than private insurance (28% vs. 42%, p < .001). Of the covariates included in the regression model, larger hernia size (cm) was the only factor significantly associated with a higher likelihood of complication (aOR 1.15 [95% CI 1.09 – 1.21]), while a laparoscopic approach (as compared to open repair) was the only factor associated with a lower likelihood of complication (aOR .36 [95% CI 0.15 – 0.90]). Hospital risk-adjusted complication rates ranged from 4.1-26.7% with an average (sd) of 11.3% (4.1).
Conclusion:Known demographic disparities among populations receiving emergency surgery are also present in eVHR. Hernia characteristics and the techniques employed in repair differ between emergency and elective ventral hernia cases and may be driving unfavorable 30-day outcomes. The heterogeneity of outcomes across sites suggest an opportunity for quality improvement.
