Unplanned readmissions after hernia repair

Several quality indices have been set up for evaluating the impact of the reduction of the length of stay (LOS), such as the 30-day unplanned readmission (UR₃₀) rate. The main goal of our study was to analyze the UR₃₀ following groin hernia repair (GHR), primary- (PVHR), and incisional ventral hernia repairs (IVHR).

A French registry-based multicenter study was conducted using prospective data from all consecutive patients registered from 2015 to 2021.

The overall incidence of UR₃₀ was 1.32%. This included 160/18,042 (0.87%) for GHR, 41/4012 (1.02%) for PVHR, and 145/3754 (3.86%) for IVHR. The leading cause of UR₃₀ was postoperative complications (P_OC). The nature of the predominant complications varied among the three categories. The correlation between UR₃₀ and P_OC (and risk factors for P_OC) was strong in GHR but was not in IVHR due to a 'protective' longer LOS in this subgroup. As the LOS has decreased over the last years, this has 'mechanically' resulted in an increase in the occurrence of UR₃₀, but not in a rise of P_OC, neither in volume nor in severity. The reduction of LOS just shifted the problem from inpatient to outpatient settings.

Since the steady development of day-care surgery, the prevention of the UR not only hinges on the prevention of the P_OC but newly on a better organization of outpatient care which is currently a huge challenge due to a GPs' and nurses' shortage in France.