Predictors of discharge destination after complex abdominal wall reconstruction

Complex ventral hernia repair is a common operation performed in a diverse population. Post-operatively, patients may have a prolonged length of stay pending facility placement. With increasing in-patient volumes, the authors aim to identify risk factors for non-home discharge to expedite placement applications and decrease length of stay.

The ACS-NSQIP database was queried for all ventral hernia repairs with separation of components performed between 2005 and 2016, excluding patients that left against medical advice or expired. Multivariate logistic regression was performed to identify independent risk factors for discharge to a facility as well as the risk for post-discharge complications following discharge to a facility after univariate analysis to compare demographics, comorbidities, and complications. Independent sample t test was done to compare mean age, body mass index and length of stay.

4549 patients met inclusion criteria. Pre-operative factors significantly associated with non-home discharge on multivariate analysis were female gender, history of diabetes, history of hypertension, older age (60+), presence of pre-operative wound infection/contaminated wound, sepsis, and dependent functional status. Intra-operative factors included ASA classification of 3 or 4 and longer operative time.

Our study was able to identify several predictive factors, mostly pre-operative, that increase the likelihood that a patient will require discharge to a facility after complex ventral hernia repair. Identification of these factors can expedite patient discharge disposition resulting in decreased length of stay, less hospital-acquired conditions, and minimized health care costs.