Patient risk factors influencing access to timely ventral hernia repairs

Optimization strategies, including weight loss, smoking cessation, and controlling blood glucose may delay ventral hernia surgery resulting in nonelective (ie, urgent or emergent) repair. Evidence on the risk factors influencing presentation that provide insight into who may be less amenable to optimization strategies are limited. This study evaluated the sociodemographic factors, insurance types, and medically optimizable factors associated with undergoing nonelective ventral hernia surgery.

This retrospective cohort study included ventral hernia repairs from the National Surgical Quality Improvement Program database from 1 January 2022 to 31 December 2023. Patient demographics, payor type, and comorbidities were evaluated for their association with surgical acuity using mixed-effects multivariable logistic regression. The primary outcome was surgical acuity.

Of the 73,589 patients from 576 hospitals, 5.8% underwent nonelective surgery. Accounting for variability between hospitals, patients who were ≥75 years old, female, Hispanic, Black/African American, uninsured or insured by select nonprivate insurances, smokers, and had a body mass index ≥30 kg/m², body mass index ≤18.5 kg/m², American Society of Anesthesiologists class III or greater, chronic obstructive pulmonary disease, ascites, heart failure, albumin <3.5 g/dL, and dependent functional status were at increased odds of undergoing nonelective surgery. Of note, patients with diabetes on oral medications had lower odds of undergoing nonelective surgery.

Several patient factors, some of which are commonly part of optimization strategies while others are immutable, were associated with nonelective surgery. Understanding the high-risk patients who undergo nonelective ventral hernia repair can inform best practices around preoperative optimization strategies and allow surgeons to tailor their approach to provide more patient-centered care.