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Readmissions and Length of Stay Increased By Anxiolytic Medications in Ventral Hernia Repairs
Crystal F. Totten*, Daniel L. Davenport, John S. Roth
Surgery, University of Kentucky, Lexington, KY
Introduction: Anxiolytic medications are prescribed with increasing frequency in the surgical patient. Our institution has previously published a negative effect of anxiolytic medications in patients undergoing noncardiac surgery. This study was aimed to evaluate perioperative characteristics and surgical implications of anxiolytic medications on ventral hernia repair outcomes.
Methods: A single-center retrospective NSQIP review of patients undergoing ventral hernia repairs performed between September 2011 and June 2013 was reviewed including anxiolytic drug (AXM) use at admission. Retrospective chart review added hernia size, estimated blood loss and concurrent procedures. Univariate analysis of patient characteristics and multivariate analysis of major morbidity compared AXM to non-AXM patients.
Results: Of the 393 patients included; 63 (15.6%) of patients were taking anxiolytics. Hypertension and dyspnea occurred more frequently (p<0.001) with those prescribed AXM. Operative characteristics for AXM noted increased median duration of operative time (152m vs. 107m; p<0.003), increased hernia size (96cm2 vs. 16cm2; p<0.001), increased EBL (100cc vs. 20cc; p<0.002), greater percentage of recurrent defects (57 vs. 35; p<0.002), doubled length of stay (4d, p<0.007) and increased readmissions rates (13 vs. 16; p<0.049). Multivariable predictors of major morbidity (p < .20) included ASA class > 2, Diabetes, Component Separation, Wound Class and Transfer Status. After adjustment for these variables, AXM use was not predictive; 1.35 (95% C.I. 0.63-2.90, p=.444).
Conclusions: Patients on anxiolytic therapy had larger hernias at the time of repair requiring concurrent procedures, longer operative times, increased blood loss, and longer length of stays with subsequent readmissions. There was no difference in major morbidity. While these medications are utilized more frequently among patients with more complex ventral hernia characteristics, causality of subsequent outcomes is uncertain.
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