title: Causes of readmission after laparoscopic and open ventral hernia repair: Identifying failed discharges and opportunities for action.
abstract: Thirty-day hospital readmissions are used as an indicator of quality for health care systems. The timing of readmissions after ventral hernia repair (VHR) is poorly defined, and its relationship to laparoscopic or open technique is unclear. The aim of this study was to assess differences between early and late readmissions after VHR.
  
  
  
  The participant use data set of the American College of Surgeons National Surgical Quality Improvement Project for 2012 was used for this study. Current procedural terminology codes for laparoscopic (n = 3,360) and open VHR (n = 9,009) were used to identify the study population. Thirty-day readmissions were grouped into early and late admissions based on the 25th percentile of days from discharge.
  
  
  
  Laparoscopic VHR had fewer 30-day readmissions (6.9% vs 9.2%, odds ratio [OR] 0.73, 95% confidence interval [CI] 0.63-0.85). The 2 most common reasons for readmission were wound occurrences (32%) and gastrointestinal disorders (14%; mostly nausea and emesis). Early readmissions occurred in 283 patients (2.3% of the entire cohort). Gastrointestinal disorders were more common in patients with early readmissions compared with late readmissions (39% vs 13%, OR 4.45, 95% CI 3.06-6.47) and were less common after open versus laparoscopic VHR (16% vs 33%, OR 2.59, 95% CI 1.75-3.84). Wound occurrences were more common in patients with late readmissions (52% vs 23%, OR 3.68, 95% CI 2.56-5.29) and more common after open VHR (49.6% vs 24.4%, OR 3.05, 95% CI 2.06-4.52).
  
  
  
  Patients with early and late readmission following VHR demonstrate different characteristics. Causes of readmission are also different and are based on timing and operative technique. Knowing the causes of readmission following VHR can potentially help clinicians prevent readmissions. Attempts to decrease early readmissions after VHR should mainly target prediction, avoidance, and management of gastrointestinal complications; efforts to decrease late readmissions should focus on the management of wound-related complications.
authors.affiliation: East Carolina University Brody School of Medicine, Greenville, NC.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Celio
authors.affiliation: East Carolina University Brody School of Medicine, Greenville, NC.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Kasten
authors.affiliation: East Carolina University Brody School of Medicine, Greenville, NC.
authors.forename: Walter E
authors.initials: WE
authors.lastname: Pofahl
authors.affiliation: East Carolina University Brody School of Medicine, Greenville, NC.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Pories
authors.affiliation: East Carolina University Brody School of Medicine, Greenville, NC. Electronic address: spaniolask@ecu.edu.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spaniolas
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States