B. Alija1, S. Vithiananthan1,2 1Harvard Medical School, Boston, MASSACHUSETTS, USA 2Cambridge Health Alliance, Department Of Surgery, Boston, MASSACHUSETTS, USA
Introduction:
In the United States, over a million hernia repair surgeries are performed each year, with over 20 million cases performed worldwide. Randomized trials have supported the “watchful waiting” approach to surgical hernia repair. In other words, unless a patient is symptomatic, immediate surgical intervention is not recommended. There are, however, risks to prolonging hernia repair, including incarceration and strangulation. While the risk of strangulation remains low, averaging 1-3% over an individual's lifetime, it is a life threatening medical emergency. Disparities in the post-operative outcomes among minority groups are widely documented in the literature. In this study, we sought to use an intersectional lens to specifically assess the disparities in post-operative outcomes across race and gender in the context of emergent strangulated hernia repair.
Methods:
Retrospective cohort study including patients that underwent emergent strangulated hernia repair in the period between 2017 and 2020 (n=1,603) among the 702 hospitals in the United States participating in American College of Surgeons National Surgical Quality Improvement Project (NSQIP). Prism 10 software utilizing One and Two way ANOVA as well as Chi Square test for independence compared the postoperative outcomes across four racial groups defined by NSQIP: White non-hispanic, Black, Asian, and Hispanic, as well as gender identity: male and female. NSQIP defines postoperative outcomes as 1) 30 day postoperative readmission and 2) 30 day postoperative reoperation. Patients with incomplete demographic and perioperative data in NSQIP were excluded from the study.
Results:
54.63% of patients identified as White Non-hispanic, 14.1% identified as Black, 1.43% identified as Asian, and 11.73% identified as Hispanic. 18% of patients either identified as mixed race or declined to answer. 38.8% (n=622) identified as men, and 61.2% (n=981) identified as women. Between 2017 and 2020, White non-hispanic patients had the highest rates of postoperative readmission (6.62%, p=0.0003), while Black patients had the highest rates of postoperative reoperation (4.9%, p=0.0257). When stratifying by gender identity, White women had the highest rates of postoperative readmission (6.53%, p<0.0001) and Black women had the highest rates of postoperative reoperation across both genders, regardless of admission status (6.9%, p=0.0017).
Conclusion:
Strangulated hernia repair is a medical emergency requiring immediate surgical intervention. Our data shows that among cases represented in NSQIP, women in general had the highest rates of postoperative complications, with Black women having the highest rates of postoperative reoperation, regardless of admission status. Future studies aim to determine the causes of these disparities, as well as intervention strategies to better target these groups and improve their outcomes.