Readmissions and Emergency Room Visits Following Outpatient and Inpatient Herniorrhaphies

Hospital readmissions following abdominal wall hernia repairs (HR) are recognized sources of additional morbidity and costs. Large-scale studies focus primarily on readmissions and do not capture emergency department visits (EDV), time-wise stratification of post-operative encounters, or outpatient HR. We aimed to determine the incidence, timing, and primary reasons for EDVs and readmissions by linking state-level databases.

Patients who underwent HR in Maryland in 2016-2017 were identified in linked state-level databases, covering 95% of all HR. Encounters were grouped by postoperative timing and admitting diagnoses. Predictors of postoperative encounters were determined.

Of 26,215 patients undergoing HR (87.5% outpatient, 48.7% inguinal), 5,802 (22.1%) had at least one postoperative encounter (4,186 EDV, 1,415 readmissions). EDV comprised 81.0% (419) of encounters within the first 48 hours. Top reasons for EDV were urinary disorders (24.1%, 10.6% and 4.0% on postoperative days (PODs) 0-2, 3-7, and 8-30, respectively), pain (18.1%, 24.9%, 14.4%), and GI complaints (10.5%, 9.9%, 3.4%). Readmissions mainly occurred for GI complaints (15.3%, 19.9%, 6.9%), local surgical site infection (SSI) (5.1%, 15.5%, 26.8%), and respiratory complications (8.2%, 6.6%, 4.1%). The most significant predictors of postoperative encounters were non-private insurance and African American origin.

ED visits and readmissions after herniorrhaphy remain major healthcare utilizations, mainly due to urinary disorders, pain, GI issues, and SSI. Insurance and race are linked to such encounters, indicating potential for targeted interventions.