Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Hernia
Published in: Hernia 2/2021

01-04-2021 | Original Article

Social determinants of health and outcomes of ventral hernia repair in a safety-net hospital setting

Authors: A. Gupta, J. B. Cadwell, A. M. Merchant

Published in: Hernia | Issue 2/2021

Login to get access

Abstract

Purpose

Lower socioeconomic status has been shown to be predictive of poorer surgical outcomes in ventral hernia repair. Recently, safety-net hospitals have been attempting to address these disparities to improve the care of patients of lower socioeconomic status.

Methods

A query of all patients undergoing ventral hernia repair at our institution between 2010 and 2019 was completed (n = 580). Patients not from identifiable New Jersey ZIP-codes were excluded (n = 572). ZIP codes were assigned quartiles based off socioeconomic variables including median household income, percent below poverty line, and high school graduation rate. Patients were then assigned to socioeconomic status quartiles based off their residential ZIP-code. Outcomes of ventral hernia surgery were compared across ZIP-code quartiles. Logistic regression was used to analyze predictors of poor outcomes.

Results

Patients from lower socioeconomic brackets were more likely to be younger (p < 0.001), female (p = 0.014), black (p < 0.001), and/or Hispanic (p = 0.003). Most notably, outcomes of ventral hernia were not significantly different between patients of different socioeconomic status ZIP-code quartiles. The risk of any post-operative morbidity was higher for longer procedures (p < 0.001) and for hernia repairs being done with other procedures (p < 0.001). Risk of prolonged length of stay and related 30-day readmission was higher with longer procedures (p < 0.001 and p = 0.003, respectively).

Conclusion

We found that outcomes of ventral hernia repair at a safety-net hospital were unaffected by socioeconomic status. This supports the important role that safety-net institutions play in providing quality care to their vulnerable populations. Future studies at other safety-net hospitals should be done to further assess the updated impact of socioeconomic status on ventral hernia outcomes.
Literature
1.
Khubchandani JA, Shen C, Ayturk D, Kiefe CI, Santry HP (2018) Disparities in access to emergency general surgery care in the United States. Surgery 163(2):243–250CrossRef
2.
Metcalfe D, Castillo-Angeles M, Olufajo OA et al (2018) Failure to rescue and disparities in emergency general surgery. J Surg Res 231:62–68CrossRef
3.
Amjad S, MacDonald I, Chambers T et al (2019) Social determinants of health and adverse maternal and birth outcomes in adolescent pregnancies: a systematic review and meta-analysis. Paediatr Perinat Epidemiol 33(1):88–99CrossRef
4.
5.
6.
Mort EA, Weissman JS, Epstein AM (1994) Physician discretion and racial variation in the use of surgical procedures. Arch Intern Med 154(7):761–767CrossRef
7.
Durand MA, Yen RW, O'Malley AJ et al (2018) What matters most: protocol for a randomized controlled trial of breast cancer surgery encounter decision aids across socioeconomic strata. BMC Public Health 18(1):241CrossRef
8.
Bush M (2018) Addressing the root cause: rising health care costs and social determinants of health. N C Med J 79(1):26–29PubMed
9.
Thornton RL, Glover CM, Cene CW, Glik DC, Henderson JA, Williams DR (2016) Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Aff (Millwood) 35(8):1416–1423CrossRef
10.
Dhar VK, Kim Y, Wima K, Hoehn RS, Shah SA (2018) The importance of safety-net hospitals in emergency general surgery. J Gastrointest Surg 22(12):2064–2071CrossRef
11.
Genther DJ, Gourin CG (2012) The effect of hospital safety-net burden status on short-term outcomes and cost of care after head and neck cancer surgery. Arch Otolaryngol Head Neck Surg 138(11):1015–1022CrossRef
12.
Dhar VK, Hoehn RS, Kim Y et al (2018) Equivalent treatment and survival after resection of pancreatic cancer at safety-net hospitals. J Gastrointest Surg 22(1):98–106CrossRef
13.
Io M (2000) America's health care safety net: intact but endangered. The National Academies Press, Washington
14.
Won RP, Friedlander S, Lee SL (2017) Outcomes and costs of managing appendicitis at safety-net hospitals. JAMA Surg 152(11):1001–1006CrossRef
15.
Hoehn RS, Wima K, Vestal MA et al (2016) Effect of hospital safety-net burden on cost and outcomes after surgery. JAMA Surg 151(2):120–128CrossRef
16.
Herrel LA, Wong SL, Ye Z, Miller DC (2016) Utilization and outcomes of inpatient surgery at safety-net hospitals. J Health Care Poor Underserv 27(4):1872–1884CrossRef
17.
Nguyen MT, Berger RL, Hicks SC et al (2014) Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy: a systematic review and meta-analysis. JAMA Surg 149(5):415–421CrossRef
18.
Lovecchio F, Farmer R, Souza J, Khavanin N, Dumanian GA, Kim JY (2014) Risk factors for 30-day readmission in patients undergoing ventral hernia repair. Surgery 155(4):702–710CrossRef
19.
Baucom RB, Ousley J, Beveridge GB et al (2016) Cancer Survivorship: defining the incidence of incisional hernia after resection for intra-abdominal malignancy. Ann Surg Oncol 23(Suppl 5):764–771CrossRef
20.
Bowman K, Telem DA, Hernandez-Rosa J, Stein N, Williams R, Divino CM (2010) Impact of race and socioeconomic status on presentation and management of ventral hernias. Arch Surg 145(8):776–780CrossRef
21.
22.
Agarwal S, Menon V, Jaber WA (2015) Outcomes after acute ischemic stroke in the United States: does residential ZIP code matter? J Am Heart Assoc 4(3):e001629CrossRef
23.
Chatterjee P, Joynt KE, Orav EJ, Jha AK (2012) Patient experience in safety-net hospitals: implications for improving care and value-based purchasing. Arch Intern Med 172(16):1204–1210CrossRef
24.
Birkmeyer NJ, Gu N, Baser O, Morris AM, Birkmeyer JD (2008) Socioeconomic status and surgical mortality in the elderly. Med Care 46(9):893–899CrossRef
25.
Fiscella K, Franks P, Meldrum S, Barnett S (2005) Racial disparity in surgical complications in New York State. Ann Surg 242(2):151–155CrossRef
26.
Askew G, Williams GT, Brown SC (1992) Delay in presentation and misdiagnosis of strangulated hernia: prospective study. J R Coll Surg Edinb 37(1):37–38PubMed
27.
Gittelsohn AM, Halpern J, Sanchez RL (1991) Income, race, and surgery in Maryland. Am J Public Health 81(11):1435–1441CrossRef
28.
Black-white disparities in health care. JAMA 1990;263(17):2344-2346
29.
Weissman JS, Stern R, Fielding SL, Epstein AM (1991) Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med 114(4):325–331CrossRef
30.
Metadata
Title
Social determinants of health and outcomes of ventral hernia repair in a safety-net hospital setting
Authors
A. Gupta
J. B. Cadwell
A. M. Merchant
Publication date
01-04-2021
Publisher
Springer Paris
Published in
Hernia / Issue 2/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-020-02203-9

Other articles of this Issue 2/2021

Hernia 2/2021 Go to the issue

Original Article

Re-do surgery after prosthetic abdominal wall repair: intraoperative findings of mesh-related complications

Original Article

Computed tomography imaging in ventral hernia repair: can we predict the need for myofascial release?

Original Article

Variation in abdominal wall closure techniques in lower transverse incisions: a nationwide survey across specialties

Original Article

A structured pathway for developing your complex abdominal hernia service: our York pathway

Original Article

Implementing preoperative Botulinum toxin A and progressive pneumoperitoneum through the use of an algorithm in giant ventral hernia repair

Letter to the Editor

Assessing the complexity of ventral hernia by methods of Tanaka, Sabbagh, Carbonell, and Love