title: Readmission following ventral hernia repair: a model derived from the ACS-NSQIP datasets.
abstract: BACKGROUND
  Institutions are now incentivized to decrease rates of preventable readmissions. The purpose of this study was to examine readmissions following open ventral hernia repair (VHR), to ultimately create a model to preoperatively identify high-risk patients.
  
  
  METHODS
  Utilizing the 2011 and 2012 ACS-NSQIP datasets, patients undergoing open VHR were identified by CPT codes. Patients who were readmitted in 2011 within 30 days of the procedure were compared to those who were not with regard to preoperative and operative characteristics. A bootstrap analysis was performed to identify internally validated risk factors to be included in the final logistic regression, which was utilized to create a weighted model to predict the risk of readmission. This model was then validated with VHR patients in 2012.
  
  
  RESULTS
  Overall, 10,745 patients were included for model generation. Of these, 850 (7.9%) patients were readmitted within 30 days. The final bootstrap analysis demonstrated that active smoking, ASA ≥ 3, a history of bleeding disorder or anemia, long operative time, inpatient status, and concurrent panniculectomy were all independently associated with readmission following ventral hernia repair. Significant variables were assigned a weighted score, ranging from 1 to 3. Each patient was then placed into one of four cohorts according to their summed score. The internally validated model [Hernia Readmission Risk (HERR) Score] demonstrated that risk increased in a linear fashion, with the highest risk cohort having a 21% risk of 30-day readmission.
  
  
  CONCLUSIONS
  Perioperative predictors of readmission following VHR include smoking, ASA score, operative magnitude, concurrent panniculectomy, and preoperative anemia and bleeding disorders. The presented model based on these factors can aid in perioperative risk stratification for readmission.
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA, jonas.nelson@uphs.upenn.edu.
authors.forename: J A
authors.initials: JA
authors.lastname: Nelson
authors.forename: J
authors.initials: J
authors.lastname: Fischer
authors.forename: C C
authors.initials: CC
authors.lastname: Chung
authors.forename: J
authors.initials: J
authors.lastname: Wink
authors.forename: A
authors.initials: A
authors.lastname: Wes
authors.forename: J M
authors.initials: JM
authors.lastname: Serletti
authors.forename: S
authors.initials: S
authors.lastname: Kovach
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010359:Patient Readmission; D018570:Risk Assessment; D012307:Risk Factors