Extending the value of the National Surgical Quality Improvement Program claims dataset to study long-term outcomes: Rate of repeat ventral hernia repair.
BACKGROUND
Existing large clinical registries capture short-term follow-up. Yet, there are many important long-term outcomes in surgery, such as recurrence of a ventral hernia after ventral hernia repair. The goal of the current study was to conduct an exploratory analysis to determine whether the rates, timing, and risk factors for ventral hernia re-repair in claims data linked to registry data were consistent with the known clinical literature.


METHODS
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and Medicare inpatient claims linked data set from 2005 to 2008 was queried to identify ventral hernia re-repairs after index ventral hernia repairs. Survival analysis was used to examine the ventral hernia re-repair rate over time and to quantify the relationship with clinical variables.


RESULTS
Of 3,730 index ventral hernia repairs identified in ACS-NSQIP, 247 patients (6.6%) underwent re-repair of a ventral hernia during the study period (2005-2008) in the Medicare claims data. ACS-NSQIP clinical variables that were associated with the ventral hernia re-repair rate in Medicare claims data 1 year after index ventral hernia repair were being a smoker (hazard ratio [HR] = 1.70, P = .02), body mass index (HR = 1.16, P = .04), and postoperative superficial surgical-site infection (HR = 2.88, P < .001).


CONCLUSIONS
Long-term rate and timing of ventral hernia re-repair obtained from claims data were an underestimate compared with clinical studies. Yet, several known clinical risk factors for recurrence in the clinical registry were associated with the re-repair rate in claims data at one year. It may be possible to study certain long-term outcomes using selected reoperation rates using the technique of linked clinical registry-claims data, with an understanding that event rates are conservative estimates.
Icahn School of Medicine, Mount Sinai Medical Center, New York, NY; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA. Electronic address: as013j@gmail.com.
Anne M
AM
Stey
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; VA Greater Los Angeles Healthcare System, Los Angeles, CA.
Marcia M
MM
Russell
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; VA Greater Los Angeles Healthcare System, Los Angeles, CA; Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA.
Catherine A
CA
Sugar
Department of Surgery, Washington University in St. Louis, Olin Business School, St. Louis, MO; Center for Health Policy, St. Louis VA Medical Center; BJC Healthcare St. Louis, MO; American College of Surgeons, Chicago, IL.
Bruce L
BL
Hall
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
David S
DS
Zingmond
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
Elise H
EH
Lawson
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; American College of Surgeons, Chicago, IL.
Clifford Y
CY
Ko
D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000453:epidemiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D016016:Proportional Hazards Models; D058996:Quality Improvement / Q000458:organization & administration*; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States