HERNIA RISK, DEPRIVATION AND FAIRER PREVENTION
Author(s)
Robert Malcolm, MSc1, Hayden Holmes, PGDIP1, Natalie Abraham, MSc2, Bev Halsey, MSc2, Sandra Van Guldener, PhD2, Gerhard Fidler, MSc2, Laurie Smith, Dr3.
1York Health Economics Consortium, York, United Kingdom, 2BD, Winnersh, United Kingdom, 3University Hospital of Wales, Cardiff, United Kingdom.
1York Health Economics Consortium, York, United Kingdom, 2BD, Winnersh, United Kingdom, 3University Hospital of Wales, Cardiff, United Kingdom.
OBJECTIVES: Incisional hernia (IH) is a common complication after abdominal surgery and is linked with additional costs, poorer health-related quality of life and mortality. Many factors used to predict IH reoccurence, including obesity, smoking and diabetes, are also associated with deprivation. This study aimed to validate the Penn Hernia Risk Model (PHRM) using Hospital Episode Statistics (HES) data in England, quantify the clinical and economic burden of IH by risk group, and assess whether PHRM risk factors are associated with higher socioeconomic deprivation.
METHODS: A retrospective observational analysis was conducted in adults undergoing intra-abdominal, urologic or gynaecologic surgery between March 2014- - 2017, with follow-up to June 2022. PHRM risk scores (v1) were calculated using weighted coefficients from Basta et al. (2019) and categorised as low (0-2), average (3-5), high (6-8) and extreme (≥9). Outcomes included operative IH repair, non-elective readmissions and inpatient costs. Targeted literature searches were used to assess whether each risk factor was associated with higher socioeconomic deprivation.
RESULTS: Among 297,134 patients, 5.09% underwent operative IH repair during a median 6.5 years of follow-up. Incidence increased by risk group: 1.8% low, 4.3% average, 9.5% high and 21.7% extreme (p < 0.001). Non-elective readmissions and inpatient costs also rose with risk group, with mean costs ranging from £2,246 to £10,244. Approximately three quarters of PHRM risk factors were associated with higher socioeconomic deprivation.
CONCLUSIONS: Applying the PHRM to HES data showed higher rates of operative IH repair, non-elective readmission and inpatient cost as risk increased. Because many risk factors were also associated with higher socioeconomic deprivation, targeted prevention may help address both clinical risk and avoidable differences in outcomes. This gives systems a measurable route to identify patients most at risk, supporting Core20 and the 10 Year Health Plan, and the Medium Term Planning Framework.
METHODS: A retrospective observational analysis was conducted in adults undergoing intra-abdominal, urologic or gynaecologic surgery between March 2014- - 2017, with follow-up to June 2022. PHRM risk scores (v1) were calculated using weighted coefficients from Basta et al. (2019) and categorised as low (0-2), average (3-5), high (6-8) and extreme (≥9). Outcomes included operative IH repair, non-elective readmissions and inpatient costs. Targeted literature searches were used to assess whether each risk factor was associated with higher socioeconomic deprivation.
RESULTS: Among 297,134 patients, 5.09% underwent operative IH repair during a median 6.5 years of follow-up. Incidence increased by risk group: 1.8% low, 4.3% average, 9.5% high and 21.7% extreme (p < 0.001). Non-elective readmissions and inpatient costs also rose with risk group, with mean costs ranging from £2,246 to £10,244. Approximately three quarters of PHRM risk factors were associated with higher socioeconomic deprivation.
CONCLUSIONS: Applying the PHRM to HES data showed higher rates of operative IH repair, non-elective readmission and inpatient cost as risk increased. Because many risk factors were also associated with higher socioeconomic deprivation, targeted prevention may help address both clinical risk and avoidable differences in outcomes. This gives systems a measurable route to identify patients most at risk, supporting Core20 and the 10 Year Health Plan, and the Medium Term Planning Framework.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR227
Topic
Clinical Outcomes, Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity
Disease
Gastrointestinal Disorders, Injury & Trauma