Impact of race and socioeconomic status on presentation and management of ventral hernias

Objective: To assess for disparity in presentation and management of ventral hernias. Design: Retrospective review. Setting: Academic center. Patients: Three hundred twenty-one patients who underwent ventral hernia repair from 2005 to 2008. Main Outcome Measures: Disparity in ventral hernia presentation, management, and outcome. Univariate analysis was conducted by unpaired t test and χ² test. Results: Black individuals were more likely than white individuals to present with acute hernia complications requiring emergent surgery (11% vs 4%; P<.01). This finding persisted after controlling for socioeconomic status (SES). Assessment by SES demonstrated patients with Medicaid were more likely to present with incarcerated or strangulated hernias (39% vs 25%; P<.001) and had longer hospital stays (4.7 vs 3 days; P<.05) as compared with patients with private insurance. Patients classified as low income had increased 30-day readmission rates as compared with average- or high-income patients (32% vs 9% vs 7%, respectively; P<.01). No difference in use of minimally invasive technique, performance of primary vs mesh repair, or postoperative morbidity or mortality was demonstrated. Twelve-month follow-up demonstrated no difference in recurrence rate by race or SES. Conclusions: Our study demonstrates the existence of disparity in patient presentation with complicated ventral hernia. Despite clear disparity by race and SES, at our institution, disparate presentation did not equate to disparate treatment or postoperative complications. No difference was demonstrated by use of operative technique, perioperative outcome, or 12-month recurrence rate. This study illustrates the need for long-term measures directed at reevaluation of organizational and institutional factors that perpetuate inequality.