title: Effect of patient and hospital characteristics on outcomes of elective ventral hernia repair in the United States.
abstract: OBJECTIVE
  Our ability to predict complications of ventral hernia repairs (VHR) are inadequate. Although impact of patient comorbidities and hospital characteristics on outcomes of several surgical procedures has been reported, such analysis on elective herniorrhaphy has not been performed to date. We hypothesized that obesity and diabetes as well as socioeconomic factors would have deleterious outcomes on elective VHR.
  
  
  METHODS
  Analysis of 2004-2008 Nationwide Inpatient Sample database. Main outcome measures included wound/systemic morbidity, length of stay, discharge status, and in-hospital mortality. Bivariate and multivariate analyses were performed to assess influence of diabetes, obesity, patient socioeconomic factors, and hospital characteristics on the outcomes of VHR.
  
  
  RESULTS
  A total of 78,348 adults undergoing elective VHR were analyzed. Obesity had significant risks for cardiopulmonary complications and prolonged hospitalization. Diabetics were more likely to have delayed wound healing. Hispanic patients had significantly higher rates of pulmonary complications and mortality. As compared to private insurance patients, Medicaid and Medicare patients had significantly higher odds of complications, prolonged hospitalization, non-routine discharge, and mortality.
  
  
  CONCLUSIONS
  Obesity and diabetes appear to be significant predictors of morbidity in patients undergoing elective VHR. Alarmingly, Medicare/Medicaid patients not only had the highest rates of wound/systemic complications but also the highest post-operative mortality. For the first time, we demonstrated that in addition to comorbidities, both patient socioeconomic factors and hospital characteristics appear to be major determinants of post-herniorrhaphy complications and mortalities. Improved health maintenance and reduction in income-related disparities in health care delivery may be paramount in improving outcomes of VHR in the United States.
authors.affiliation: Case Comprehensive Hernia Center, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA, yuri.novitsky@uhhospitals.org.
authors.forename: Y W
authors.initials: YW
authors.lastname: Novitsky
authors.forename: S B
authors.initials: SB
authors.lastname: Orenstein
mesh_terms: D000328:Adult; D015897:Comorbidity; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006555:Hernia, Ventral / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009765:Obesity / Q000453:epidemiology*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000145:classification / Q000209:etiology / Q000401:mortality; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology