Ventral hernia repair with permanent mesh for non-Hispanic black versus white patients: access and post-operative outcomes in the era of robotic surgery

Authors

Grace F. Chao, Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA. gchao405@gmail.com.Follow
Lee Ying, Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA.Follow
Li-Ching Huang, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Jianing Ma, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA.
Saber Ghiassi, Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA.Follow
Karen E. Gibbs, Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA.Follow
Geoffrey Nadzam, Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA.Follow
John Morton, Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA.Follow
Andrew Duffy, Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA.Follow
Randal Zhou, Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA.Follow

Document Type

Article

Publication Title

Surgical endoscopy

Abstract

BACKGROUND: Robotic ventral hernia surgery may provide better patient outcomes. Whether it is provided equitably based on race remains unknown. METHODS: We examined whether patients from the Abdominal Core Health Quality Collaborative who were Black had equitable access to robotic surgery for ventral hernia repair with permanent mesh compared to white counterparts from 2013 to 2023. We performed propensity-score matching to address confounding and then chi-squared testing to examine access to robotic, laparoscopic, and open approaches. Secondary outcomes included 30-day readmissions, complications, and death and 1- and 2-year hernia recurrence and quality of life measured by HerQLes Summary and PROMIS Pain T-Scores analyzed with chi-squared, Fisher exact, and Wilcoxon testing. RESULTS: 2397 patients identified as Black, and 21,900 identified as white. Our propensity-score matched cohort included 2374 Black patients and 7122 white. Black and white groups had the same rates of laparoscopy (15% vs 15%). Patients who identified as Black were more likely to undergo robotic surgery (36% vs 32%). Open approach was 49% for Black and 53% for white (p = 0.005). For 30-day complications, we found Black patients were more likely to experience reoperation (2% vs 1%, p = 0.005) and less likely surgical site infection (1% vs 2%, p < 0.001). Hernia recurrence scores and perceived abdominal health based on HerQLes were not statistically significantly different. At 2 years, absolute reported T-Scores were higher for Black patients (median 40 (IQR 31-49) vs 36 (31-46), p = 0.031). CONCLUSIONS: This is the first large-scale study examining access to robotic surgery, complications, and quality of life measures. We found patients who identified as Black were more likely than white counterparts to undergo robotic surgery, but they were more likely to require reoperation and had higher pain scores. Our data suggest equitable access still may not translate to equitable patient outcomes.

DOI

10.1007/s00464-024-11252-5

Publication Date

10-21-2024

Recommended Citation

Chao, Grace F.; Ying, Lee; Huang, Li-Ching; Ma, Jianing; Ghiassi, Saber; Gibbs, Karen E.; Nadzam, Geoffrey; Morton, John; Duffy, Andrew; and Zhou, Randal, "Ventral hernia repair with permanent mesh for non-Hispanic black versus white patients: access and post-operative outcomes in the era of robotic surgery" (2024). Surgery. 179.
https://scholar.bridgeporthospital.org/surgery/179

Identifier

39433584 (pubmed); 10.1007/s00464-024-11252-5 (doi); 10.1007/s00464-024-11252-5 (pii)