Effect of community distress on utilization of complex abdominal wall techniques for moderate- to large-sized ventral...

The environment in which people live plays a direct role on their physical health and can influence their health outcomes. This is especially pronounced when patients undergo complex procedures, such as large ventral hernia repair. However, the relationship between socioeconomic status and community distress and the type of intraoperative techniques that may contribute to postoperative outcomes and return to function has not been explored.

Adults aged 18 or older in the Abdominal Core Health Quality Collaborative (ACHQC) from 2013 to 2023 underwent elective abdominal wall reconstruction for a hernia greater than or equal to 5 cm. Zip codes were then matched to the Distressed Communities Index, which is a measure of community distress based on 7 indicators of economic prosperity, and 5 unique quintiles were created based on score: prosperous (0-20), comfortable (21-40), mid-tier (41-60), at-risk (61-80), and distressed (81-100). Pearson and Kruskal-Wallis tests were used.

A total of 15,973 patients were included in the study, comprised of 2572 (16.1%) distressed, 2847 (17.8%) at-risk, 3186 (19.9%) moderate, 3459 (21.7%) comfortable, and 3909 (24.5%) prosperous. Those in the most distressed communities had greater proportions of female, non-white, and younger patients and exhibited greater rates of hypertension, diabetes, and COPD (p < 0.001). Those in the distressed group had the greatest rates of open repair (p < 0.001) and had the longest operations. There was no significant difference in transversus abdominis release (TAR) (p = 0.12) or sublay placement (p = 0.31). However, there were significantly higher rates of intraoperative complication, as well as greater length of stay, readmission, postoperative complication, surgical site infection (SSI), surgical site occurrence (SSO), and surgical site occurrence requiring procedural intervention (SSOP) (p < 0.01).

Despite not identifying significant differences in performance of complex abdominal wall techniques between distressed community quintiles, there is evidence that these patients' intraoperative and postoperative outcomes differ from their peers who return home to more prosperous settings. A myriad of postoperative issues, including complications and infections, is especially troublesome among those in distressed communities as it may be more difficult to access the required follow-up care and make a full recovery.