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World Journal of Surgery

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01-11-2020 | Wound Infection | Original Scientific Report

Predictors of 30- and 90-Day Readmissions After Complex Abdominal Wall Reconstruction With Biological Mesh: A Longitudinal Study of 232 Patients

Authors: Shekhar Gogna, Rifat Latifi, James Choi, Jorge Con, Kartik Prabhakaran, Abbas Smiley, Patrice L. Anderson

Published in: World Journal of Surgery | Issue 11/2020

Abstract

Background

Hospital readmissions are recognized as indicators of poor healthcare services which further increase patient morbidity. The aim of this study is to analyze predicting factors for the 30-day and 90-day readmissions after a complex abdominal wall reconstruction (CAWR).

Methods

A pooled analysis of the prospective study and retrospective database patients undergoing CAWR with acellular porcine dermis from 2012 to 2019 was carried out. Independent t test for continuous variables and Chi-square and Fischer's exact tests for categorical variables were used. A multivariable logistic regression model and linear regression analysis were used to analyze the independent predictors of 30-day and 90-day readmissions.

Results

A total of 232 patients underwent CAWR, and the readmission rate (RR) was 16.8% (n = 40). The 30-day and 90-day RR was 11.3% (n = 23) and 13.3% (n = 33), respectively. There were no statistical differences in age, frailty, and gender distribution between the two groups. There was no difference in ASA score, type of component separation, ventral hernia working group class, size of the biological mesh, placement of mesh, and intestinal resection rate. The Clavien–Dindo complications and mean comprehensive complication index (CCI) were higher in the readmission group as compared to no readmission group (p < 0.01). Readmitted patients had higher surgical site infections (p < 0.01) and wound necrosis (p = 0.01). Higher CCI, past or concomitant pelvic surgery, and the presence of enterocutaneous fistula were independent predictors of earlier days to readmission.

Conclusion

Surgical site occurrences were associated with 30-day and 90-day readmissions after CAWR, while the presence of ascites and dialysis was associated with 90-day readmissions.

Tsai TC, Joynt KE, Orav EJ et al (2013) Variation in surgical readmission rates and quality of hospital care. N Engl J Med 12:1134–1142CrossRef

Jencks SF, Brock JE (2013) Hospital accountability and population health: lessons from measuring readmission rates. Ann Intern Med 9:629–630CrossRef

McIlvennan CK, Eapen ZJ, Allen LA (2015) Hospital readmissions reduction program. Circulation 20:1796–1803. https://doi.org/10.1161/CIRCULATIONAHA.114.010270CrossRef

Wechter ME, Pearlman MD, Hartmann KE et al (2005) Reclosure of the disrupted laparotomy wound: a systematic review. Obstet Gynecol 2:376–383CrossRef

Trimbos JB, Smit IB, Holm JP et al (1992) A randomized clinical trial comparing two methods of fascia closure following midline laparotomy. Arch Surg 10:1232–1234CrossRef

Luijendijk RW, Hop WC, van den Tol MP et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 6:392–398CrossRef

Blatnik JA, Harth KC, Aeder MI et al (2011) Thirty-day readmission after ventral hernia repair: predictable or preventable? Surg Endosc 25:1446–1451CrossRef

Helgstrand F, Rosenberg J, Kehlet H et al (2011) Nationwide analysis of prolonged hospital stay and readmission after elective ventral hernia repair. Dan Med Bull 10:A4322

Helgstrand F, Rosenberg J, Kehlet H et al (2013) Nationwide prospective study of outcomes after elective incisional hernia repair. J Am Coll Surg 2:217–228CrossRef

10.

Nguyen MT, Li LT, Hicks SC et al (2013) Readmission following open ventral hernia repair: incidence, indications, and predictors. Am J Surg 6:942–948CrossRef

11.

Lovecchio F, Farmer R, Souza J et al (2014) Risk factors for 30-day readmission in patients undergoing ventral hernia repair. Surgery 4:702–710CrossRef

12.

Baltodano PA, Webb-Vargas Y, Soares KC et al (2016) A validated, risk assessment tool for predicting readmission after open ventral hernia repair. Hernia 1:119–129CrossRef

13.

Nelson JA, Fischer J, Chung CC et al (2015) Readmission following ventral hernia repair: a model derived from the ACS-NSQIP datasets. Hernia 1:125–133CrossRef

14.

Gogna S, Latifi R, Policastro A, et al (2020) Complex abdominal wall hernia repair with biologic mesh in elderly: a propensity matched analysis. Herni Jan 24. [Epub ahead of print] https://doi.org/10.1007/s10029-019-02068-7.

15.

Latifi R, Samson DJ, Gogna S, et al (2020) Perioperative complications of complex abdominal wall reconstruction with biologic mesh: A pooled retrospective cohort analysis of 220 patients from two academic centers. Int J Surg 74:94–99. [Epub ahead of print 2020 Jan 8]. https://doi.org/10.1016/j.ijsu.2019.12.035.

16.

Latifi R, Samson D, Haider A et al (2017) Risk-adjusted adverse outcomes in complex abdominal wall hernia repair with biologic mesh: A case series of 140 patients. Int J Surg 43:26–32. https://doi.org/10.1016/j.ijsu.2017.05.031CrossRefPubMed

17.

von Elm E, Altman DG, Egger M et al (2007) Strengthening the Reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335:806–808CrossRef

18.

Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36(5):309–332CrossRef

19.

Morales-Conde S, Suárez-Artacho G, Socas M et al (2013) Influence of fibrin sealant in preventing postoperative seroma and normalizing the abdominal wall after laparoscopic repair of ventral hernia. Surg Endosc 9:3214–3329. https://doi.org/10.1007/s00464-013-2894-7CrossRef

20.

Velanovich V, Antoine H, Swartz A et al (2013) Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res 1:104–110CrossRef

21.

Clavien PA, Strasberg SM (2009) Severity grading of surgical complications. Ann Surg 2:197–198CrossRef

22.

Clavien PA, Vetter D, Staiger RD et al (2017) The comprehensive clinical index (CCI): added value and clinical perspectives 3 years “down the line”. Ann Surg 6:1045–1050CrossRef

23.

Muysoms F, Campanelli G, Champault GG et al (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia 3:239–250CrossRef

24.

Lovecchio F, Farmer R, Souza J et al (2014) Risk factors for 30-day readmission in patients undergoing ventral hernia repair. Surgery 155:702–710CrossRef

25.

Blatnik JA, Harth KC, Aeder MI et al (2011) (2011) Thirty-day readmission after ventral hernia repair: predictable or preventable? Surg Endosc 5:1446–1451CrossRef

26.

Giordano SA, Garvey PB, Baumann DP et al (2018) Hospital readmission following open, single-stage, elective abdominal wall reconstructions using acellular dermal matrix affects long-term hernia recurrence rate. Am J Surg 1:60–66. https://doi.org/10.1016/j.amjsurg.2018.01.072CrossRef

27.

Trujillo CN, Fowler A, Al-Temimi MH et al (2018) Complex ventral hernias: a review of past to present. Perm J 22:17–015. https://doi.org/10.7812/TPP/17-015CrossRefPubMed

28.

Atema JJ, Furnée EJ, Maeda Y et al (2017) Major complex abdominal wall repair in contaminated fields with use of a non-cross-linked biologic mesh: a dual-institutional experience. World J Surg 8:1993–1999. https://doi.org/10.1007/s00268-017-3962-2CrossRef

29.

Howard R, Thompson M, Fan Z et al (2019) Costs associated with modifiable risk factors in ventral and incisional hernia repair. JAMA Netw Open 11:e1916330. https://doi.org/10.1001/jamanetworkopen.2019.16330CrossRef

Title: Predictors of 30- and 90-Day Readmissions After Complex Abdominal Wall Reconstruction With Biological Mesh: A Longitudinal Study of 232 Patients
Authors: Shekhar Gogna
Rifat Latifi
James Choi
Jorge Con
Kartik Prabhakaran
Abbas Smiley
Patrice L. Anderson
Publication date: 01-11-2020
Publisher: Springer International Publishing
Keywords: Wound Infection
Ascites
Published in: World Journal of Surgery / Issue 11/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05714-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictors of 30- and 90-Day Readmissions After Complex Abdominal Wall Reconstruction With Biological Mesh: A Longitudinal Study of 232 Patients

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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