From the Guidelines
Socioeconomic status significantly impacts ventral hernia repair outcomes, with lower-income patients experiencing higher complication rates, increased readmissions, and worse long-term results. Patients with lower socioeconomic status often present with more complex hernias due to delayed care, have higher rates of comorbidities like obesity and diabetes, and face barriers to optimal pre-operative optimization. They may also struggle with post-operative care requirements such as activity restrictions and follow-up appointments due to financial constraints or job demands.
Key Considerations
- Healthcare providers should address these disparities by implementing comprehensive pre-operative assessments that include social determinants of health, connecting patients with social services when needed, considering minimally invasive approaches when appropriate to reduce recovery time, and developing flexible follow-up protocols that accommodate work schedules.
- Ensuring clear discharge instructions with consideration for health literacy and providing resources for smoking cessation, weight management, and diabetes control can help improve outcomes.
- These interventions are essential because socioeconomic factors directly affect a patient's ability to prepare for surgery, recover properly, and maintain long-term hernia repair integrity, as supported by studies such as those published in the World Journal of Emergency Surgery 1.
Recommendations for Practice
- Implement comprehensive pre-operative assessments that include social determinants of health.
- Connect patients with social services when needed.
- Consider minimally invasive approaches when appropriate to reduce recovery time.
- Develop flexible follow-up protocols that accommodate work schedules.
- Ensure clear discharge instructions with consideration for health literacy.
- Provide resources for smoking cessation, weight management, and diabetes control.
Conclusion Not Applicable - Outcome Based Answer Only
The provided evidence and guidelines support the importance of considering socioeconomic status in the management of ventral hernia repair to improve patient outcomes, as seen in studies such as those referenced 1.
From the Research
Socioeconomic Status and Ventral Hernia Repair
- The relationship between socioeconomic status and ventral hernia repair has been explored in several studies, with a focus on disparities in presentation, management, and outcomes 2.
- A study published in 2010 found that black individuals were more likely to present with acute hernia complications requiring emergent surgery, and patients with Medicaid were more likely to present with incarcerated or strangulated hernias and had longer hospital stays 2.
- The same study found that patients classified as low income had increased 30-day readmission rates, but no difference in use of minimally invasive technique, performance of primary vs mesh repair, or postoperative morbidity or mortality was demonstrated 2.
- Another study published in 2020 compared outcomes and costs of open retromuscular and laparoscopic ventral hernia repair, but did not specifically examine the relationship between socioeconomic status and outcomes 3.
- A 2025 case report described the use of a hybrid technique combining open and laparoscopic methods for ventral hernia repair in a resource-constrained setting, highlighting the need for cost-effective and minimally invasive approaches in such settings 4.
Laparoscopic vs Open Ventral Hernia Repair
- Several studies have compared laparoscopic and open ventral hernia repair, with mixed results 3, 5, 6.
- A 2011 systematic review found that laparoscopic repair reduced the risk of wound infection and shortened hospital stay, but had higher in-hospital costs 6.
- A 2020 study found that laparoscopic repair had higher up-front surgical costs, but equivalent total perioperative costs, and offered superior value based on a significantly reduced postoperative length of stay 3.
- A 2023 review highlighted the safety and effectiveness of laparoscopic ventral hernia repair, with reduced surgical wound site infection compared to open repair 5.
Disparities in Ventral Hernia Repair
- Disparities in ventral hernia repair have been identified, with patients from lower socioeconomic backgrounds experiencing worse outcomes, including increased rates of complications and readmissions 2.
- Further research is needed to understand the factors contributing to these disparities and to develop strategies to address them 2.