Evaluating the Effect of Socioeconomic Status on Complex Abdominal Wall Reconstruction Outcomes

In complex abdominal wall reconstruction, maintenance and follow-up are vital to effective long-term patient care. This can present a challenge for individuals from a low-income household who may have less ability to afford time away from work or caring for dependents as well as challenges with transportation to and from follow-up appointments. Given the expenses and high complication rate in abdominal wall reconstruction, we elected to determine whether socioeconomic status had an impact on patient outcomes.

After obtaining institutional review board approval, all patients who underwent complex abdominal wall reconstruction between 2002 and 2021 by the senior author were reviewed in a retrospective cohort analysis of a prospectively maintained database. Complications were classified into overall, major, infection, and delayed wound healing. Outcomes were classified into recurrence and reoperation. The cohort was divided by median household income (MHI) level and race.

A total of 478 patients received complex abdominal wall repair over a 19-year interval. A total of 324 patients identified MHI as <$75,000 (low MHI), and 154 patients identified MHI as > $75,000 (high MHI). Mean patient age was 53.9 (SD, 12.3) years. Mean patient body mass index (BMI) was 32.1 (SD, 7.8) kg/m 2 . There was no significant difference in age between the 2 MHI cohorts. There was a significant difference in BMI between MHI cohorts, with higher BMI among patients with low MHI ( P = 0.0001). The majority of risk factors and surgical techniques were comparable. There was a statistically significant difference in hernia etiology, with higher rates of recurrent hernia repair among patients with low MHI ( P = 0.007). The risk of overall complications ( P = 0.0307) and delayed wound healing ( P = 0.0263) was higher among patients with low MHI. Median household income was found to be an independent risk factor for complications after controlling for BMI, diabetes mellitus, and hernia etiology. There was no significant difference in follow-up time between cohorts.

Patients with low MHI who undergo complex abdominal wall reconstruction are at an increased risk for complications and poor outcomes, including delayed wound healing and hernia recurrence. This indicates the need to provide resources to address barriers to follow-up and maintenance following complex abdominal wall reconstruction in this patient cohort.