Thirty-day readmission after ventral hernia repair: predictable or preventable?

Introduction: Thirty-day readmission has become an increasingly scrutinized event in the field of surgery, especially in light of projected cuts in reimbursement. Although studies have evaluated large populations, little work has been done on procedure-specific populations. Our objective is to determine if any factors are predictive of 30-day readmission in patients undergoing ventral hernia repair.

Methods: We retrospectively reviewed the charts of all patients who underwent laparoscopic or open ventral hernia repair over a 4-year period. We evaluated patients based on demographic, preoperative, and operative variables. The primary outcome measure was all-cause 30-day readmission.

Results: There were 420 patients identified for evaluation. Fifty-one (12%) patients required readmission to the hospital within 30 days. The most common indications for readmission were wound infection (57%; n=29) and gastrointestinal (GI) complication (19%; n=10). On analysis, demographic variables were similar between the two groups. However, patients who were readmitted were more likely to have had more prior abdominal surgeries (4 vs. 2; p<0.0001), more previous hernia repairs (2 vs. 1; p=0.006), open repair (76% vs. 46%; p<0.0001), and active abdominal infection (37% vs. 12%; p<0.0001). In addition, patients also had longer procedures (235 vs. 150 min; p<0.0001) and larger defects (350 vs. 96 cm2; p<0.0001). On multivariate analysis, independent predictors of readmission included presence of fistula [odds ratio (OR)=8.55; 95% confidence interval (CI) 3.21-22.72], defect size>300 cm2 (OR=5.35; 95% CI 2.59-11.05), active abdominal infection (OR=4.37; 95% CI 2.28-8.37), and open repair (OR=4.27; 95% CI 2.17-8.42).

Conclusions: Patients undergoing ventral hernia repair can represent a complex group. In our practice, enterocutaneous fistula, defect size>300 cm2, active abdominal infection, and open repair were all independent risk factors (OR>4) for 30-day readmission after ventral hernia repair. Recognition of these high-risk patients can help focus resources to increase surveillance and possible early intervention to reduce readmissions.