Impact of race and socioeconomic status on presentation and management of ventral hernias.
OBJECTIVE
To assess for disparity in presentation and management of ventral hernias.


METHODS
Retrospective review.


METHODS
Academic center.


METHODS
Three hundred twenty-one patients who underwent ventral hernia repair from 2005 to 2008.


METHODS
Disparity in ventral hernia presentation, management, and outcome. Univariate analysis was conducted by unpaired t test and chi(2) test.


RESULTS
Black individuals were more likely than white individuals to present with acute hernia complications requiring emergent surgery (11% vs 4%; P < .01). This finding persisted after controlling for socioeconomic status (SES). Assessment by SES demonstrated patients with Medicaid were more likely to present with incarcerated or strangulated hernias (39% vs 25%; P < .001) and had longer hospital stays (4.7 vs 3 days; P < .05) as compared with patients with private insurance. Patients classified as low income had increased 30-day readmission rates as compared with average- or high-income patients (32% vs 9% vs 7%, respectively; P < .01). No difference in use of minimally invasive technique, performance of primary vs mesh repair, or postoperative morbidity or mortality was demonstrated. Twelve-month follow-up demonstrated no difference in recurrence rate by race or SES.


CONCLUSIONS
Our study demonstrates the existence of disparity in patient presentation with complicated ventral hernia. Despite clear disparity by race and SES, at our institution, disparate presentation did not equate to disparate treatment or postoperative complications. No difference was demonstrated by use of operative technique, perioperative outcome, or 12-month recurrence rate. This study illustrates the need for long-term measures directed at reevaluation of organizational and institutional factors that perpetuate inequality.
Bowman
Kimberly
K
Division of General Surgery, The Mount Sinai Medical Center, New York, NY 10029, USA.
Telem
Dana A
DA
Hernandez-Rosa
Jonatan
J
Stein
Natalie
N
Williams
Ruth
R
Divino
Celia M
CM
D000208:Acute Disease; D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006555:Hernia, Ventral / Q000150:complications / Q000175:diagnosis / Q000208:ethnology* / Q000473:pathology* / Q000601:surgery; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012923:Social Class; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data