Association of DCI with number of preoperative comorbidities and 30-day outcomes following inguinal hernia repair: an analysis of the ACHQC database

Maha Mourad; Julie E Kim; Sharon E Phillips; Vishal M Kothari; Ivy N Haskins

doi:10.1007/s00464-024-11381-x

Association of DCI with number of preoperative comorbidities and 30-day outcomes following inguinal hernia repair: an analysis of the ACHQC database

Surg Endosc. 2024 Nov 13. doi: 10.1007/s00464-024-11381-x. Online ahead of print.

Authors

Maha Mourad¹, Julie E Kim¹, Sharon E Phillips², Vishal M Kothari¹, Ivy N Haskins³

Affiliations

¹ Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
² Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
³ Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. ivhaskins@gmail.com.

PMID: 39537863
DOI: 10.1007/s00464-024-11381-x

Abstract

Introduction: The Distressed Communities Index (DCI) is a stratification tool that captures socioeconomic disparities based on zip code. To date, no prior study has investigated the association of DCI score and inguinal hernia repair outcomes. This study aims to evaluate the association between DCI score and 30-day outcomes following inguinal hernia repair using the Abdominal Core Health Quality Collaborative (ACHQC) database. We hypothesize that patients with higher DCI scores will have a higher number of comorbidities and 30-day postoperative events.

Methods and procedures: All patients who underwent inguinal hernia repair from 2015 to 2023 with an available DCI score and 30-day follow-up data available were included. Patients were stratified into DCI quintiles based on zip code. Primary outcomes of interest were 30-day hernia-specific postoperative outcomes. Pearson's chi-squared and Kruskal-Wallis tests were used to compare DCI scores with comorbid conditions and perioperative outcomes.

Results: 30,927 patients were included for analysis; 12,206 patients were classified as prosperous (40%), 7190 patients as comfortable (23%), 4884 patients as mid-tier (16%), 3485 patients as at-risk (11%), and 3162 as distressed (10%). Distressed patients were more likely to have ASA 3 or higher and comorbidities including hypertension, diabetes, ESRD, and COPD (p < 0.001). Patients with higher DCI scores were significantly more likely to undergo an emergency operation and have a longer OR time (p < 0.001). Distressed patients were also more likely to experience a major wound complication requiring readmission (p = 0.05) and reoperation (p < 0.001).

Conclusion: DCI scores are strongly linked to surgical risk and outcomes following inguinal hernia repair. Special consideration should be given to DCI scores when optimizing patients prior to inguinal hernia repair.

Keywords: Comorbidities; Complications; Distressed community index; Hernia outcomes; Inguinal hernia repair; Risk factors.