title: Mortality after inpatient open ventral hernia repair: developing a risk stratification tool based on 55,760 operations.
abstract: BACKGROUND
  The medical complexity of hernia patients imparts higher risk for complications, and mortality is a distinct reality. No study has stratified patients based on preoperative risk for open ventral hernia repair (VHR) specifically. We utilized the American College of Surgeons National Surgical Quality Improvement Program to create a mortality risk stratification model following VHR.
  
  
  METHODS
  Patients undergoing open VHR were identified from American College of Surgeons National Surgical Quality Improvement Program databases. Baseline variables correlated with mortality risk were entered into stepwise regression and bootstrap analysis. β-Coefficients were used to weigh each factor, yielding the risk assessment tool.
  
  
  RESULTS
  A total of 55,760 patients were included with a mortality of 1.34%. Predictors of mortality included the following: functional status (odds ratio [OR] = 2.87), liver disease (OR = 3.61), malnutrition (OR = 1.43), age greater than 65 years (OR = 2.39), American Society of Anesthesiologists 4 or higher (OR = 2.90), systemic inflammation (OR = 1.99), and contamination (OR = 2.15). Patients were risk stratified into low risk (mortality .33%), moderate risk (mortality 1.86%), high risk (mortality 8.76%), and extreme risk groups (mortality 34.2%). Unplanned reoperations and medical complications increased across risk groups. The model demonstrated high discriminatory ability with a C-statistic value of .86.
  
  
  CONCLUSIONS
  This study provides an accurate model to predict mortality risk specific to open VHR. The strongest predictors were American Society of Anesthesiologists, liver disease, functional status, and older age. This tool may inform clinical decision making to reduce complications.
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Marten N
authors.initials: MN
authors.lastname: Basta
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wink
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA, USA. Electronic address: stephen.kovach@uphs.upenn.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
mesh_terms: D000328:Adult; D002423:Cause of Death; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D006555:Hernia, Ventral / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007813:Laparotomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012372:ROC Curve; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D020379:Risk Adjustment; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Adult; Herniorrhaphy; Inpatient; Open surgical procedures; Postoperative mortality; Risk modeling