Patient Factors that Predict Complicated Hernia Presentation Using the National Hospital Ambulatory Medical Care Survey (NHAMCS)

Aims: Patient age and insurance status can lead to presentation with complicated hernias. Surgery for complicated hernias results in greater morbidity, mortality, and healthcare costs compared to elective repair of uncomplicated hernias. This study explores the association between insurance status and age with presentation of complicated inguinal hernia.

Methodology: Data from Center for Disease Control (CDC) National Hospital Ambulatory Medical Care Survey (NHAMCS) for 1992-2010 of inguinal hernia encounters from emergency department and outpatient visits were selected and combined. This cross-sectional study compared presentation of complicated inguinal hernia with explanatory variables of insurance status and age through chi-square and logistic regression analysis. Ethnicity and sex were potential confounders.

Results: Of the 1452 inguinal hernia encounters, 4.1% were complicated. Lack of insurance did not predict presentation with a complicated hernia (OR=0.11, 95%CI [0.04-0.35]), even after adjusting for age, sex, and ethnicity. Age 65 years and older was a strong predictor of complicated hernia presentation (P<.0001). The reduced odds of presenting with a complicated hernia for those without insurance persisted across different age groups.

Conclusion: Our results suggest that age is a strong predictor of complicated hernia presentation; however, lack of insurance is not. Elderly patients, regardless of insurance status, should be considered for early elective hernia repair.