Surgical and non-surgical treatment of inguinal hernia during non-elective admissions in the Nationwide Readmissions Database

Abstract

Inguinal hernia repair is one of the most common surgical operations, yet the optimal treatment strategy remains undefined. Treatment of symptomatic inguinal hernias include both surgical and non-surgical approaches. The objective of this study was to determine differences in population, readmission rates, and costs between operative and non-operative approaches for patients admitted non-electively for an inguinal hernia in a national dataset. In addition, we sought to define the baseline characteristics of the two groups and identify potential predictive factors in the non-surgically managed subgroup who were readmitted and treated operatively within 90 days of their first visit. This study was a retrospective review of data from the Nationwide Readmissions Database (NRD) from 2010 to 2014. Patients above age 18 who were admitted non-electively for a primary diagnosis of inguinal hernia were included. Patients whose length of stay was\u2009<\u20091% or\u2009>\u200995% percentile or died during the initial visit were excluded. Readmissions within 90 days of the initial visit were flagged. Patients were classified according to initial management strategy: operative versus non-operative. Demographic, clinical, and organizational characteristics were compared between the two cohorts. 14,249 patients met inclusion criteria and were operative (n\u2009=\u20098996, 63.13%) and non-operative (n\u2009=\u20095255, 36.88%) cohorts. When comparing the two groups, readmission rate was lower (0.49% for surgical, 1.78% for non-surgical, p\u2009<\u20090.01), mean length of stay (LOS) longer (3.27 [SE\u2009=\u20090.05] days for surgical, 2.76 days [SE\u2009=\u20090.06] for non-surgical, p\u2009<\u20090.01), and mean total cost higher ($9597 for surgical, $7167 for non-surgical, p\u2009<\u20090.01) in surgically treated patients. The non-surgical population was on average older (63.05 years for surgical, 64.52 years for non-surgical, p\u2009<\u20090.01) with more chronic conditions (3.57 for surgical, 4.05 for non-surgical, p\u2009<\u20090.01). Of the patients initially managed non-surgically, 1.78% (n\u2009=\u200991) were readmitted, and of them, 62.63% (n\u2009=\u200957) were readmitted and managed surgically within 90 days of initial admission (i.e., crossed over from watchful waiting to surgical treatment). Average number of chronic conditions (3.79 versus 4.03, p\u2009=\u20090.74), average number of comorbidities (2.26 versus 2.18, p\u2009=\u20090.87), and average total number of ICD-9 discharge codes (7.44 versus 8.23 p\u2009=\u20090.54 did not differ significantly between the operative versus non-operative sample of the readmitted population. The total cost ($5562.38 versus $8737.28, p\u2009=\u20090.01) was greater in the operative versus non-operative sample. Watchful-waiting strategy is the most common treatment approach in patients admitted non-electively for symptomatic inguinal hernia. Readmission after non-elective hospitalization for inguinal hernia is rare, but surgical intervention decreased the likelihood of readmission compared to non-operative management, while also increasing LOS and cost of care. Our data supports a patient centric approach to the management; non-surgical treatment is a viable temporary option even in symptomatic inguinal hernias, while surgical treatment may reduce the likelihood of future readmission.