Recent (2016-2018) Nationwide Trends In Abdominal Wall Reconstruction (AWR) And Readmission
*Sullivan A Ayuso1, *Bola G Aladegbami1, *Raageswari B Nayak1, Bradley R Davis1, *Paul D Colavita1, *John P Fischer2, *Vedra A Augenstein1, *B Todd Heniford1
1Carolinas Medical Center, Charlotte, NC;2University of Pennsylvania, Philadelphia, PA
OBJECTIVE(S): In complex AWR operations, the use of component separation technique (CST) increases the rate of fascial closure but is associated with increased wound complications. This study examines recent trends in operative volume and readmissions for patients undergoing AWR with CST.
METHODS: The Nationwide Readmissions Database was queried for patients undergoing open AWR from 2016-2018 using ICD-10 PCS codes. For patients undergoing AWR with CST, demographic characteristics, operative volume, and 90-day readmissions were determined. CST readmissions were compared to non-CST readmissions. Standard statistical methods and logistic regression were used.
RESULTS: Over the three-year period, 180,635 patients underwent AWR, and 6,467 patients (3.6%) underwent AWR/CST. Each year, there was an increase in percentage of patients undergoing AWR/CST: 2.7% in 2016, 3.9% in 2017, 4.2% in 2018 (p<0.01), which is a 64.2% increase over 3 years.
For AWR/CST patients, the mean Charlson Comorbidity Index (CCI) score was 1.1 (range: 0-13); 11.2% were smokers, 22.4% diabetic, and 33.3% obese. Most operations were performed at urban teaching hospitals (81.0%), which accounted for 93.4% of the increase in CST performed (p<0.01). There was no difference in CCI between hospital type (p=0.25). Mean length of stay (LOS) was 7.7 days, and there was a 1.0% in-hospital mortality. Mean time to readmission was 24.4±22.3 days. The 90-day readmission rate did not change with yearly rates of 16.5%, 18.9%, and 17.7% (p=0.20); readmissions were similar to non-CST patients, which had rates of 17.2%, 17.3%, and 17.5% (p=0.26). Most commonly, readmissions were for infection (37.0%) and sepsis (4.8%). Of those re-admitted, 18.0% required reoperation, and 13.1% required drain placement. The mean charge per readmission was $64,625. Urban-teaching hospitals had the highest readmission rates compared to urban non-teaching and rural hospitals (18.6% vs.14.8%vs.15.1%, p=0.01). Other factors associated with increased readmission included non-elective operation, increased age, patient comorbidities, weekend admission, payer type, metropolitan location, and longer LOS following AWR; each was significant in univariate and multivariate analysis (all p < 0.05).
CONCLUSIONS: From 2016-2018, there was a 64% increase nationwide in the use of CST in hernia repair. Ninety-day readmissions remained stable and were comparable to AWR without CST.
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