Ryan Howard1, Emily Johnson2, Nicholas L Berlin3, Zhaohui Fan4, Michael Englesbe5, Justin B Dimick6, Dana A Telem7. 1. Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA; Center for Healthcare Outcomes & Policy, Ann Arbor, MI, USA. 2. University of Michigan Medical School, Ann Arbor, MI, USA. 3. Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA; National Clinical Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Center for Healthcare Outcomes & Policy, Ann Arbor, MI, USA. 4. Center for Healthcare Outcomes & Policy, Ann Arbor, MI, USA. 5. Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA. 6. Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA; Center for Healthcare Outcomes & Policy, Ann Arbor, MI, USA; Division of Minimally Invasive Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA. 7. Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA; Center for Healthcare Outcomes & Policy, Ann Arbor, MI, USA; Division of Minimally Invasive Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA. Electronic address: dtelem@med.umich.edu.
Abstract
BACKGROUND: Ventral hernia repair is an extremely common operation, however the variability in patient outcomes between individual hospitals and surgeons is unclear. We analyzed variability in 30-day complication rates and identified specific complications that contributed to this variability. METHODS: Retrospective, cross-sectional analysis of 30-day complication rates following ventral hernia repair across 73 hospital and 978 surgeons between January 1, 2014 and December 31, 2018. RESULTS: Data were collected on 19,007 patients who underwent VIHR at 73 hospitals across 978 surgeons. Adjusted complication rate among hospitals was 6.2% (range 4.3%-12.8%) and among surgeons was 6.2% (range 3.5%-26.8%). Variation between lowest and highest quartile surgeons was greatest for acute kidney injury (0.12% vs. 1.71%, P < 0.001), superficial surgical site infection (0.33% vs. 3.62%, P < 0.001), sepsis (0.27% vs. 2.47%, P < 0.001), and catheter-associated urinary tract infection (0.02% vs. 0.30%, P < 0.001). CONCLUSION: After adjusting for a number of patient-specific clinical variables, there is significant variation in 30-day complication rates after ventral hernia repair. This represents a significant opportunity to improve patient outcomes.
BACKGROUND:Ventral hernia repair is an extremely common operation, however the variability in patient outcomes between individual hospitals and surgeons is unclear. We analyzed variability in 30-day complication rates and identified specific complications that contributed to this variability. METHODS: Retrospective, cross-sectional analysis of 30-day complication rates following ventral hernia repair across 73 hospital and 978 surgeons between January 1, 2014 and December 31, 2018. RESULTS: Data were collected on 19,007 patients who underwent VIHR at 73 hospitals across 978 surgeons. Adjusted complication rate among hospitals was 6.2% (range 4.3%-12.8%) and among surgeons was 6.2% (range 3.5%-26.8%). Variation between lowest and highest quartile surgeons was greatest for acute kidney injury (0.12% vs. 1.71%, P < 0.001), superficial surgical site infection (0.33% vs. 3.62%, P < 0.001), sepsis (0.27% vs. 2.47%, P < 0.001), and catheter-associated urinary tract infection (0.02% vs. 0.30%, P < 0.001). CONCLUSION: After adjusting for a number of patient-specific clinical variables, there is significant variation in 30-day complication rates after ventral hernia repair. This represents a significant opportunity to improve patient outcomes.
Authors: Quintin P Solano; Jyothi R Thumma; Cody Mullens; Ryan Howard; Anne Ehlers; Lia Delaney; Brian Fry; Mary Shen; Michael Englesbe; Justin Dimick; Dana Telem Journal: Surg Endosc Date: 2022-08-12 Impact factor: 3.453