Lower Socioeconomic Status Increases Risk for Hospital Readmission After Hernia Repair

In a nationwide review of nearly 400,000 patients who underwent open or laparoscopic ventral and inguinal hernia repair, readmission rates were 11.56% and 17.94% at 30 and 90 days, respectively. Yet hernia patients with lower socioeconomic status may have elevated risk of readmission, according to a study presented at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2021 Annual Meeting.

The study, which the authors believe is the first to focus on purely on socioeconomic status and hernia repair readmission rates using a nationwide data set, found that lower socioeconomic status is a statistically significant independent predictor of hernia repair readmission.

Study Examined Characteristics of Patients Readmitted After Hernia Repair

Researchers examined the charts of 389,342 laparoscopic and open ventral and inguinal hernia repair patients, using data from the 2016–2017 Nationwide Readmission Database. Of these, approximately half were elective procedures.

Here are some of notable results:

• • Medicaid patients who underwent laparoscopic and open repairs were 25% and 23% more likely to be readmitted at 30 and 90 days, respectively
  • The leading diagnoses associated with 30- and 90-day readmission were:
    • Postprocedural streptococcal sepsis
    • Sepsis, unspecified organism
    • Postprocedural intestinal obstruction
    • Unspecified intestinal obstruction
    • Acute kidney failure, unspecified
  • Patients in the lowest zip code income quartile were more likely to be readmitted compared to patients in the top two highest income quartiles
  • The same lower income patients were also more likely to present with emergent repairs
  • Patients least likely to face readmission after ventral and inguinal hernia repair, at both 30 and 90 days, were those who underwent a laparoscopic repair, had elective admission, care in a teaching hospital or care in an urban hospital.

The authors note that the study does have limitations. For example, zip codes were used to determine socioeconomic status and may not fully reflect individual or household wealth. Also, the database review did not consider the reason a patient had a laparoscopic versus open ventral hernia repair, size of the defect, patient race, ethnicity or education.

Addressing Socioeconomic Risk for Hospital Readmission After Hernia Repair

Although there have been multiple studies demonstrating disparity of medical care for minorities and patients of lower socioeconomic status, there have been none that shed light on the association solely between socioeconomic status and hernia readmission rates.

Given that patients lower-income patients may delay hernia treatment and present with more emergent cases, the study authors recommend strategies to target these populations in an attempt to reduce hospital readmission after hernia repair.

They suggest promoting earlier care and intervention and improving access to minimally invasive techniques and elective cases. They note that patients with lower socioeconomic status may work in more physically demanding professions, so readmission after surgery could have a disproportionate effect on the labor pool. Therefore, they also suggest occupational health or support programs for hernia health.

However, the financial burden of medical care is a pronounced factor in the U.S. The Kaiser Family Foundation found that 24% of U.S. adults have put off visits to doctors’ offices and 13% have put off hospital services (13%) due to cost. High health care costs disproportionately affect uninsured adults, Black and Hispanic adults, and those with lower incomes—larger shares of U.S. adults in each of these groups report difficulty affording various types of care and delayed or went without medical care as a result.

Even patients who have health insurance struggle. Nearly half (46%) of insured adults find it difficult to  afford their out-of-pocket costs, and one in four (27%) have difficulty affording their deductible.

In order to determine if cost could be dismissed as a determining factor in readmission after hernia repair, a 2022 Canadian study examined inguinal hernia repair readmission rates patients in the context of a universal healthcare system. It found that socioeconomic disparities were not significantly associated with emergency surgical repair, and that lower income was not associated with worse outcomes in an environment with equitable access to healthcare. However, the study did find that patients with lower incomes did have a higher readmission rate, which the authors say could be because home care and prescription drugs are not universally covered in Canada, prompting patients to present to the emergency department if any complications arise.

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