Costs Associated With Modifiable Risk Factors in Ventral and Incisional Hernia Repair

作者：Ryan Howard, Michael P. Thompson, Zhaohui Fan, Michael J. Englesbe, Justin B. Dimick, Dana A. Telem · 发表于：JAMA Network Open · 年份：2019 · DOI：10.1001/jamanetworkopen.2019.16330 · 被引用次数：89 · 研究领域：Hernia repair and management、Bariatric Surgery and Outcomes、Surgical site infection prevention

Importance: Ventral and incisional hernia repair (VIHR) is an extremely common operation, after which complications are also fairly common. A number of preoperative risk factors are known to contribute to increased complications after surgical repair; however, the individual relative association of these risk factors with adverse outcomes and increased spending is unclear. Quantifying the association of individual risk factors may help surgeons implement targeted surgical optimization, improve outcomes, and reduce spending. Objective: To identify the attributable association of modifiable risk factors for adverse outcomes after VIHR on outcomes and episode-of-care payments. Design, Setting, and Participants: This cross-sectional study was performed using a population-based sample of adult patients and episode spending data from January 1, 2012, to December 31, 2018, from a statewide multipayer registry. A multilevel mixed-effects logistic regression model was used to examine the contribution of patient-specific risk factors to adverse outcomes. Attributable risk and population attributable risk fraction were calculated to estimate the additional spending attributable to individual risk factors. Data were analyzed from April 2018 to September 2018. Main Outcomes and Measures: Any complications, serious complication, discharge not to home, 30-day emergency department utilization, and 30-day readmission. Episode-of-care spending was calculated for these outcomes. Results: This s...