Do National Databases Underestimate Complications in Ventral Hernia Repair? A Single Institution's Perspective
Brittany Perzia, B.S.1, Christopher Jou, B.S.2, Joseph Mellia, B.A.1, Edward Carey, B.S.1, Kailash Kapadia, B.S.1, Gurtej Singh, PhD3, Jocellie Marquez, MD3, Sami Khan, MD3.
1Stony Brook University School of Medicine, Stony Brook, Long Island, NY, USA, 2Stony Brook University School of Medicine, Stony Brook, Long Island, NY, USA, 3Stony Brook University Medical Center Division of Plastic and Reconstructive Surgery, Stony Brook, Long Island, NY, USA.
Ventral hernia repair (VHR) can be associated with significant, costly complications such as surgical site infection (SSI), hernia recurrence, and readmission. National databases can offer insight, but some often only report 30-day post-operative outcomes. This brief time period could underestimate complications, which may limit a surgeon's ability to counsel patients and risk stratify patients. This study investigates long-term postoperative complication rates associated with VHR up to 90-days and beyond.
Charts of patients who underwent VHR with mesh from January 2009 to June 2017 at a single institution were retrospectively reviewed. Demographic data, comorbidities, recurrence rates, and postoperative complications within 30 days, between 31-90 days, and >90 days were identified. Inclusion criteria were ventral hernia repair with fascial defects of at least 30 cm2 and follow up of at least 6 months
185 patients were identified who met the inclusion criteria. Mean age was 58 years, and the mean BMI was 32.1. The overall recurrence rate was 23.8% (n=44), with an average time to recurrence of 27 months. Consistent with the literature, SSI (7.6%) was the most common complication, with rates lower than other reported series. In addition, 21.5% (n=3), 50% (n=7), and 28.6% (n=4) of SSIs occurred within 30 days, between 31-90 days, and >90 days, respectively. Readmission rates related to the initial VHR were 30.3% (n=20), 22.7% (n=15), and 47.0% (n=31) within 30 days, between 31-90 days, and >90 days, respectively.
Our data show that the majority of SSIs, hernia recurrences, and VHR related readmissions occur more than 30-days postoperatively. This suggests that some national databases may underreport overall complication rates. This study further validates the need for extending database reporting beyond 30 days in order to accurately evaluate outcomes for complex abdominal wall reconstruction.
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