Community distress as a predictor of early hernia recurrence for older adults undergoing ventral hernia repair (VHR),Surgical Endoscopy

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Community distress as a predictor of early hernia recurrence for older adults undergoing ventral hernia repair (VHR)
Surgical Endoscopy ( IF 3.1 ) Pub Date : 2022-09-22 , DOI: 10.1007/s00464-022-09587-y
Savannah M Renshaw ₁ , Molly A Olson ₂ , Benjamin K Poulose ₁ , Courtney E Collins ₁

Affiliation

Background

Social cohesion and neighborhood support have been linked to improved health in a variety of fields, but is not well-studied among the elderly population. This is particularly evident in surgical populations. Therefore, this study sought to assess the potential role of community distress in predicting early hernia recurrence among older adults.

Methods

The Abdominal Core Health Quality Collaborative (ACHQC) was used to identify patients aged 65 or older undergoing elective ventral hernia repair with zip code data available. Patients were linked to the Distressed Communities Index (DCI), which is a national database that assigns a score of 0–100 to each zip code based on 7 measures of neighborhood prosperity. Quintiles were used to compare groups: prosperous (0–20), comfortable (21–40), mid-tier (41–60), at-risk (61–80), and distressed (81–100). Distressed (0–20), at-risk (21–40), mid-tier (41–60), comfortable (61–80), and prosperous (81–100). Time to recurrence for neighborhood distress quintiles was examined using a Cox proportional hazards model.

Results

In total, 9819 patients were included in the study, including 3056 (31.1%) prosperous, 2307 (23.5%) comfortable, 1795 (18.2%) mid-tier, 1390 (14.2%) at-risk, and 1271 (12.9%) distressed. Distressed communities had lower mean age and greater proportion of racial minorities (p < 0.001). Open repairs were significantly more common among the distressed group (66.7%), as were all comorbidities (p < 0.001). Recurrence-free survival was shorter for distressed communities compared to prosperous after adjusting for baseline characteristics (HR 1.3, 95% CI 1.07–1.67, p = 0.01). Mean time to recurrence was lowest for patients living in distressed communities, indicating the worst recurrence rates, while mean time to recurrence was greatest for those in prosperous zip codes (p < 0.001).

Conclusion

Older VHR patients presenting from distressed zip codes, as identified by the Distressed Communities Index, experience hernia recurrence significantly sooner as compared to patients from prosperous zip codes. This study may provide evidence of the role of neighborhood and environmental factors in caring for older patients following VHR.

Graphical abstract

中文翻译：

社区困扰作为接受腹疝修补术 (VHR) 的老年人早期疝气复发的预测因子

背景

社会凝聚力和邻里支持与各个领域的健康改善有关，但在老年人口中尚未得到充分研究。这在手术人群中尤为明显。因此，本研究旨在评估社区压力在预测老年人早期疝气复发中的潜在作用。

方法

腹部核心健康质量协作 (ACHQC) 用于识别 65 岁或以上接受选择性腹疝修补术的患者，并提供可用的邮政编码数据。患者与贫困社区指数 (Distressed Communities Index, DCI) 相关联，该指数是一个国家数据库，根据邻里繁荣的 7 项指标为每个邮政编码分配 0-100 分。五分位数用于比较组别：富裕 (0–20)、舒适 (21–40)、中等 (41–60)、风险 (61–80) 和苦恼 (81–100)。苦恼 (0–20)、风险 (21–40)、中等 (41–60)、舒适 (61–80) 和繁荣 (81–100)。使用 Cox 比例风险模型检查邻里困扰五分位数的复发时间。

结果

总共有 9819 名患者被纳入研究，其中 3056 名 (31.1%) 富裕，2307 名 (23.5%) 舒适，1795 名 (18.2%) 中等，1390 名 (14.2%) 处于风险中，1271 名 (12.9%)苦恼。陷入困境的社区平均年龄较低，少数族裔比例较高 ( p < 0.001)。与所有合并症一样，痛苦组 (66.7%) 的开放修复明显更常见 ( p < 0.001)。调整基线特征后，与繁荣社区相比，贫困社区的无复发生存期更短 (HR 1.3, 95% CI 1.07–1.67, p = 0.01）。生活在贫困社区的患者的平均复发时间最短，表明复发率最低，而生活在繁荣邮政编码地区的患者的平均复发时间最长 ( p < 0.001)。