Recurrent emergent hernia repairs: who is at risk?

Abstract

Background: Patients undergoing recurrent emergent hernia repairs may represent some of the most vulnerable patients in the healthcare system. However, this population has not been adequately characterized to date, limiting identification of opportunities for intervention.

Methods: We conducted a retrospective cross-sectional study of Medicare beneficiaries who underwent an index emergent or urgent ventral hernia repair between 2011 and 2021. We performed a multivariable risk-adjusted Royston-Parmar survival analysis for cumulative recurrent emergent hernia repair incidence within 10 years, accounting for patient comorbidities, demographics, and repair characteristics. We assessed patient, provider, and community factors associated with an increased risk of recurrent emergent hernia repair. We used the Social Vulnerability Index, a publicly available score from the CDC reflecting 15 sociodemographic factors, to measure social risk.

Results: Among 120,227 Medicare beneficiaries who underwent emergent hernia repair during the study period, the mean (SD) age was 71 (12) and 58% were female. At 10 years, the cumulative incidence of recurrent emergent hernia repair was 6.4% (95% CI 6.2-6.7). Median time to recurrent repair was 1.6 years [IQR 0.8-3.2]. Risk-adjusted factors associated with increased risk for recurrent emergent repair include female sex (10-year Hazard Ratio [HR] 1.58, 95% CI [1.24-2.02]), Hispanic ethnicity (10-year HR 1.19, 95% CI [1.01-1.41]), and patients in the highest quintile of social vulnerability (10-year HR 1.33, 95% CI [1.03-1.71]). Hernias repaired via open approach (10-year HR 1.44, 95% CI [1.03- 2.01) and at for-profit hospitals (10-year HR 1.16, 95% CI [1.06-1.26]) also experienced increased risk.

Conclusion: Female, Hispanic, and socially vulnerable patients are at increased risk of recurrent emergent hernia repairs, as well as patients receiving an open index repair and care at for-profit hospitals. Our study highlights opportunities for intervention, including consideration of index repair approach and populations that may benefit from closer follow-up and earlier elective intervention for hernia recurrence.