Sex, race, and socioeconomic distinctions in incisional hernia management.
Hernia repair
Incisional hernia
Racial disparities
Socioeconomic status
Surgical decision-making
Journal
American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
received:
12
01
2023
revised:
16
03
2023
accepted:
04
04
2023
medline:
4
9
2023
pubmed:
10
4
2023
entrez:
9
4
2023
Statut:
ppublish
Résumé
We sought to explore the impact of sex, race, and insurance status on operative management of incisional hernias. A retrospective cohort study was conducted to explore adult patients diagnosed with an incisional hernia. Adjusted odds for non-operative versus operative management and time to repair were queried. Of the 29,475 patients with an incisional hernia, 20,767 (70.5%) underwent non-operative management. In relation to private insurance, Medicaid (aOR 1.40, 95% CI 1.27-1.54), Medicare (aOR 1.53, 95% CI 1.42-1.65), and uninsured status (aOR 1.99, 95% CI 1.71-2.36) were independently associated with non-operative management. African American race (aOR 1.30, 95% CI 1.17-1.47) was associated with non-operative management while female sex (aOR 0.81, 95% CI 0.77-0.86) was predictive of elective repair. For patients who underwent elective repair, both Medicare (aOR 1.40, 95% CI 1.18-1.66) and Medicaid (aOR 1.49, 95% CI 1.29-1.71) insurance, but not race, were predictive of delayed repair (>90 days after diagnosis). Sex, race, and insurance status influence incisional hernia management. Development of evidence-based management guidelines may help to ensure equitable care.
Sections du résumé
BACKGROUND
We sought to explore the impact of sex, race, and insurance status on operative management of incisional hernias.
METHODS
A retrospective cohort study was conducted to explore adult patients diagnosed with an incisional hernia. Adjusted odds for non-operative versus operative management and time to repair were queried.
RESULTS
Of the 29,475 patients with an incisional hernia, 20,767 (70.5%) underwent non-operative management. In relation to private insurance, Medicaid (aOR 1.40, 95% CI 1.27-1.54), Medicare (aOR 1.53, 95% CI 1.42-1.65), and uninsured status (aOR 1.99, 95% CI 1.71-2.36) were independently associated with non-operative management. African American race (aOR 1.30, 95% CI 1.17-1.47) was associated with non-operative management while female sex (aOR 0.81, 95% CI 0.77-0.86) was predictive of elective repair. For patients who underwent elective repair, both Medicare (aOR 1.40, 95% CI 1.18-1.66) and Medicaid (aOR 1.49, 95% CI 1.29-1.71) insurance, but not race, were predictive of delayed repair (>90 days after diagnosis).
CONCLUSIONS
Sex, race, and insurance status influence incisional hernia management. Development of evidence-based management guidelines may help to ensure equitable care.
Identifiants
pubmed: 37032236
pii: S0002-9610(23)00147-2
doi: 10.1016/j.amjsurg.2023.04.001
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
202-206Informations de copyright
Copyright © 2023. Published by Elsevier Inc.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors declare that they have no conflict of interest.