Equivalent outcomes after elective inguinal hernia repair for patients living near and far from care

Distance to care has been associated with worse clinical outcomes. Whether this is true for patients traveling to centers of excellence for elective inguinal hernia repair is unclear.

Patients undergoing elective, first-time, clean, unilateral inguinal hernia repair with permanent synthetic mesh from 2016 to 2023 within the Abdominal Core Health Quality Collaborative registry were identified. Patients were stratified by the distance between their home and surgical site, with cohorts of less than 5, 5-10, 10-20, 20-30, 30-60, and greater than 60 miles. Association between distance and clinical outcomes (readmission, infection, reoperation, recurrence, and quality of life) were evaluated, with follow-up data available for all patients at 30 days and for some up to 5 years.

A total of 14,206 patients met inclusion criteria. Patients living further tended to be older (p < 0.001), less racially diverse (p < 0.001), and covered by Medicare and Medicaid rather than private insurance (p < 0.001). Most comorbidities did not differ except for liver failure (p < 0.001), ascites (p < 0.001), anticoagulation (p < 0.001), immunosuppression (p < 0.001), and higher ASA class (p < 0.001), all associated with more distant cohorts. Hernia size did not differ. Patients farther from care were more likely to undergo open rather than minimally invasive repair with 37% open for patients > 60 miles vs. 33% open for < 5 miles (p < 0.001). Clinical outcomes including readmission, infection, reoperation, and recurrence (up to 5 years) were comparable regardless of distance traveled. Quality of life improvements were greatest at 6 months post-operatively in patients living 30-60 miles from care.

Distance to care is not associated with increased surgical site infections or recurrence after elective inguinal hernia repair. Further study of rurality and social determinants of health in hernia care is needed.