Who's paying? Payor status significantly affects hospital readmission rates after ventral hernia repair.

Abstract

Purpose: Over 350,000 ventral hernia repairs (VHRs) are performed annually. However, there are numerous socioeconomic disparities in obtaining elective repair. This study aimed to evaluate the impact of payer status after ventral hernia repair within a national cohort on thirty-day readmission rates, hospital costs, and discharge disposition.

Methods: A retrospective chart review was conducted of the Nationwide Readmission Database (NRD) for all VHRs between 2016 and 2022. Demographic characteristics along with medical comorbidities, complications after VHR, and all-cause 30-day readmissions were collected. Logistic regression was used to assess associations between payer status and overall outcomes.

Results: Medicaid (12.1%) and Medicare (12.4%) were the primary payer statuses among all readmissions. Patients with private insurance (OR 0.71, p < 0.001) and self-pay (OR 0.81, p < 0.001) had lower odds of thirty-day readmission compared to Medicaid patients. Patients discharged to a short-term facility, designated center, home healthcare, or against medical advice were more likely to be re-admitted compared to patients who were discharged home (p < 0.05). The most common cause for re-admission among all patients was post-operative/device infection. Medicaid patients had the highest rate of such infections (2.20 vs. 1.68 Medicare, 1.45 Private, and 1.56 Self-Pay).

Conclusions: Payer status significantly influences readmission rates, cause for readmission, and overall discharge disposition among VHR patients. These findings might implicate underlying socioeconomic disparities in receiving adequate post-operative care. Future studies should investigate how insurance structures impact postoperative care and clinical outcomes in hernia surgery.