Venous thromboembolism-related readmission after ventral hernia repair in the United States: a propensity score-matched analysis of open and minimally invasive surgery and insights from a national database.

BACKGROUND: Ventral hernia repairs (VHR) are common surgical procedures, yet patients remain at risk for serious postoperative complications, including hospital readmission secondary to venous thromboembolism (VTE). While minimally invasive surgical (MIS) approaches have shown benefits in reducing other complications and hospital length of stay (LOS), their impact on VTE-related readmissions has been less extensively studied. METHODS: This retrospective cohort study utilized the Nationwide Readmissions Database (NRD) from 2016 to 2022 to identify adult patients undergoing VHR, categorizing them into open or MIS approaches. The primary outcome was non-elective 30-day readmission for VTE. Secondary outcomes included LOS, in-hospital mortality at readmission, and total inpatient hospitalization costs. To minimize selection bias and balance baseline characteristics between open and MIS approaches, a propensity score-matched (PSM) analysis was performed, with specific subgroup analyses for hernia type and surgical complexity. RESULTS: Initially, 834,298 patients were identified (Open: 74.5%; MIS: 25.5%). After propensity score matching (n = 418,846), the difference in 30-day VTE-specific readmission was no longer statistically significant (Open 1.98% vs. MIS 2.37%; OR 1.19, 95% CI 0.97-1.46, p = 0.088). MIS was significantly associated with lower odds of all-cause 30-day readmission (OR 0.76, 95% CI 0.74-0.78, p < 0.001), shorter length of stay (4.35 vs. 5.35 days, p < 0.001), and slightly lower hospital costs ($22,315 vs. $23,304, p < 0.001). Independent predictors for VTE-specific readmission included age > 65 years (OR 1.84, p = 0.001) and discharge with home healthcare (p = 0.026). CONCLUSION: The surgical approach was not a significant predictor of VTE-related readmission. Patient-related factors were associated with VTE-related readmissions, although the relative contribution of these factors could not be determined due to lack of granular data within this dataset. Studies focusing on risk-stratification and care optimization for high-risk patients are crucial for further improving patient outcomes.