Is distance a barrier to postoperative follow-up? a cox proportion analysis of geographic, financial, and clinical factors in ventral hernia repair outcomes.

introductionThe adequate follow-up (FU) of patients undergoing ventral hernia repair (VHR) is crucial for both detecting recurrence and addressing health disparities. Loss to FU can significantly affect clinical outcomes, as it hinders timely interventions and long-term monitoring. Factors such as demographic characteristics, comorbidities, socioeconomic status, and access to care may all influence the likelihood of loss of FU. We aimed to provide a time-dependent analysis of factors associated with the time of postoperative FU and factors influencing FU loss in a specialized hernia center.

methodsPatients who underwent VHR between 2021 and 2023 were identified through medical chart review. Demographic, geographical, and clinical data were collected. FU was defined as days from surgery to the last office visit, and loss of FU was defined as failure to attend two consecutive scheduled clinic visits with no documented clinical contact for more than 6 months after the last visit. As a surrogate for social, financial, and geographical factors, the Distressed Communities Index (DCI) was used based on patients' ZIP codes. A Cox proportional hazards regression was used to analyze time-to-event data. Variables were selected based on clinical relevance as an exploratory analysis, including the DCI, out-of-city residency, sex, age, hospital length of stay (LOS), race, psychological diagnosis type of hernia, approach (robotic versus open), transversus abdominis release (TAR), hernia size, concomitant procedures, mesh use, postoperative emergency visits and reoperation, surgical site infection (SSI), surgical site occurrences (SSO), recurrence, chronic pain. Model assumptions were assessed, including proportional hazards. Hazard ratios (HR) and 95% confidence intervals (CI) were computed, and statistical significance was assessed using Wald tests. Model performance was evaluated with the concordance index (C-index). Kaplan Meier curves were built for factors identified as relevant for FU loss. All analyses were conducted using R.

resultsThis study analyzed 264 ventral hernia repair patients (2021-2023; median age 56, BMI 30.3) to identify factors associated with post-operative FU loss. Baseline characteristics included 39.4% recurrent hernias and 22.7% with psychiatric conditions. Postoperative complications were low, but FU significantly declined over time (e.g., 53.0% at 1 year, 12.1% at 3 years). Unadjusted analyses showed open surgical approach, in-city residency, lower DCI, and a prior psychiatric diagnosis were associated with better FU. Multivariable Cox regression revealed that increased age reduced FU loss (HR 0.97). Geographic factors significantly impacted FU, with out-of-city residency (HR 1.82) and higher DCI (HR 1.74) both independently associated with increased FU discontinuation.

conclusionOur findings suggest that the geographical, social, and financial factors represented by the DCI significantly influence the risk of the event. In addition, increased age was associated with reduced risk of FU loss, whereas out-of-city residency and higher DCI were associated with increased risk of FU discontinuation.