Environmental Justice Index and 30-Day Wound Morbidity After Ventral Hernia Repair

Place-based vulnerability may contribute to wound morbidity after ventral hernia repair (VHR), but the relevance of multidomain Environmental Justice Index (EJI) rankings is uncertain. We evaluated associations between overall and module-specific EJI rankings and 30-day wound outcomes.

This retrospective cohort study included 35,626 patients undergoing clean VHR with hernia width ≤18 cm in the Abdominal Core Health Quality Collaborative. Parastomal hernias and repairs involving anterior component separation were excluded. Overall EJI and social, environmental, health, and climate module rankings were modeled per 0.1-point increase. Multivariable logistic regression with institution-clustered robust standard errors evaluated surgical site infection (SSI), surgical site occurrence (SSO), and SSO requiring procedural intervention (SSOPI), adjusting for patient, hernia, and operative characteristics.

SSI, SSO, and SSOPI occurred in 1.9%, 8.1%, and 1.8%, respectively. Overall EJI was associated with SSOPI (OR 1.05, 95% CI 1.01-1.09), but not SSI or SSO. Social vulnerability was associated with SSO (OR 1.06, 95% CI 1.02-1.10) and SSOPI (OR 1.09, 95% CI 1.05-1.14). Health vulnerability was associated with SSI (OR 1.03, 95% CI 1.00-1.07), whereas climate burden was inversely associated with SSI (OR 0.95, 95% CI 0.91-0.99). Highest-versus-lowest EJI stratum absolute risk differences were not statistically significant.

Social vulnerability demonstrated the most consistent association with wound morbidity after VHR. EJI may provide complementary contextual information for perioperative assessment, but modest absolute differences do not support its use as a standalone clinical decision tool.