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Early Wound Morbidity after Open Ventral Hernia Repair with Biosynthetic or Polypropylene Mesh
Abstract
BACKGROUND: Recently introduced slow-resorbing biosynthetic and non-resorbing macroporous polypropylene meshes are being used in hernias with clean-contaminated and contaminated wounds. However, information about the use of biosynthetic meshes and their outcomes compared with polypropylene meshes in clean-contaminated and contaminated cases is lacking. Here we evaluate the use of biosynthetic mesh and polypropylene mesh in elective open ventral hernia repair (OVHR) and investigate differences in early wound morbidity after OVHR within clean-contaminated and contaminated cases. STUDY DESIGN: All elective, OVHR with biosynthetic mesh or uncoated polypropylene mesh from January 2013 through October 2016 were identified within the Americas Hernia Society Quality Collaborative. Association of mesh type with 30-day wound events in clean-contaminated or contaminated wounds was investigated using a 1:3 propensity-matched analysis. RESULTS: Biosynthetic meshes were used in 8.5% (175 of 2,051) of elective OVHR, with the majority (57.1%) used in low-risk or comorbid clean cases. Propensity-matched analysis in clean-contaminated and contaminated cases showed no significant difference between biosynthetic mesh and polypropylene mesh groups for 30-day surgical site occurrences (20.7% vs 16.7%; p = 0.49) or unplanned readmission (13.8% vs 9.8%; p = 0.4). However, surgical site infections (22.4% vs 10.9%; p = 0.03), surgical site occurrences requiring procedural intervention (24.1% vs 13.2%; p = 0.049), and reoperation rates (13.8% vs 4.0%; p = 0.009) were significantly higher in the biosynthetic group. CONCLUSIONS: Biosynthetic mesh appears to have higher rates of 30-day wound morbidity compared with polypropylene mesh in elective OVHR with clean-contaminated or contaminated wounds. Additional post-market analysis is needed to provide evidence defining best mesh choices, location, and surgical technique for repairing contaminated ventral hernias.
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“To date, this concept has only been assessed in a cohort of complex cases involving clean-contaminated and contaminated wounds, which contributed a number of confounding factors to the analysis and prevented definitive conclusions (14).”
In the citing paper
“However, the data generated provide unique insight into the “real-world” use of these biomaterials in low-risk umbilical and ventral hernia repairs without the confounding factors that may have influenced wound morbidity in previously reported complex cases (14).”
In the citing paper
“suggesting that the fully resorbable P4HB did not negatively impact early wound morbidity as speculated in previous studies involving complex patients with clean-contaminated or contaminated wounds (14).”
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Cites
Huerta, S., Varshney, A., Patel, P. M., Mayo, H. G., & Livingston, E. H. (2016) · JAMA Surgery · doi:10.1001/jamasurg.2015.5234 · Cited by 71
Cited by
Deeken, C. R., Rosen, M. J., Poulose, B. K., Bradbury, K., Huang, L.-C., Ma, J., & Badhwar, A. (2023) · Frontiers in Surgery · doi:10.3389/fsurg.2023.1280991 · Cited by 7
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Metadata
- Authors
- Sahoo, S., Haskins, I. N., Huang, L.-C., Krpata, D. M., Derwin, K. A., Poulose, B. K., & Rosen, M. J.
- Venue
- Journal of the American College of Surgeons
- Published
- 2017-10
- Volume
- 225
- Issue
- 4
- Pages
- 472-480e1
- ISSN
- 1072-7515
- Cited by
- 47
- References
- 1
- Language
- en
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- Sahoo, S., Haskins, I. N., Huang, L.-C., Krpata, D. M., Derwin, K. A., Poulose, B. K., & Rosen, M. J. (2017). Early Wound Morbidity after Open Ventral Hernia Repair with Biosynthetic or Polypropylene Mesh. Journal of the American College of Surgeons. https://doi.org/10.1016/j.jamcollsurg.2017.07.1067
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