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Predictors of mesh infection and explantation after abdominal wall hernia repair
José Bueno-Lledó1, Antonio Torregrosa-Gallud1, Angela Sala-Hernandez1
1Surgical Unit of Abdominal Wall, Department of Digestive Surgery, Politecnic "La Fe" Hospital, University of Valencia, Valencia, 46008, Spain.
Background:
The main objective was to identify predictive factors associated with prosthesis infection and mesh explantation after abdominal wall hernia repair (AWHR).
Methods:
This is a retrospective review of all patients who underwent AWHR from January 2004 to May 2014 at a tertiary center. Multivariate analysis identified predictors of mesh infection and explantation after AWHR.
Results:
From 3,470 cases of AWHR, we reported 66 cases (1.9%) of mesh infection, and 48 repairs (72.7%) required mesh explantation. Steroid or immunosuppressive drugs use (odds ratio [OR] 2.22; confidence interval [CI] 1.16 to 3.95), urgent repair (OR 5.06; CI 2.21 to 8.60), and postoperative surgical site infection (OR 2.9; CI 1.55 to 4.10) were predictive of mesh infection. Predictors of mesh explantation were type of mesh (OR 3.13; CI 1.71 to 5.21), onlay position (OR 3.51; CI 1.23 to 6.12), and associated enterotomy in the same procedure (OR 5.17; CI 2.05 to 7.12).
Conclusions:
Immunosuppressive drugs use, urgent repair, and postoperative surgical site infection are predictive of mesh infection. Risk factors of prosthesis explantation are polytetrafluoroethylene mesh, onlay mesh position, and associated enterotomy in the same procedure.
Insights
Predictors of mesh infection after abdominal wall hernia repair (AWHR) include immunosuppressive drugs, urgent repair, and surgical site infection. Mesh explantation risks involve mesh type, onlay position, and enterotomy.
Area of Science:
- Abdominal Wall Surgery
- Surgical Materials Science
- Infectious Disease Epidemiology
Background:
- Abdominal wall hernia repair (AWHR) is common, but complications like mesh infection and explantation can occur.
- Identifying factors predicting these complications is crucial for improving patient outcomes.
- Previous studies have explored various risk factors, but a comprehensive analysis is needed.
Purpose of the Study:
- To identify predictive factors for mesh infection following AWHR.
- To identify predictive factors for mesh explantation after AWHR.
Main Methods:
- Retrospective review of 3,470 AWHR cases from January 2004 to May 2014.
- Multivariate analysis to determine predictors of mesh infection and explantation.
- Statistical analysis including odds ratios (OR) and confidence intervals (CI).
Main Results:
- Mesh infection occurred in 1.9% of cases (66/3,470), with 72.7% (48/66) requiring mesh explantation.
- Predictors of mesh infection: immunosuppressive drug use (OR 2.22), urgent repair (OR 5.06), and postoperative surgical site infection (OR 2.9).
- Predictors of mesh explantation: polytetrafluoroethylene (PTFE) mesh (OR 3.13), onlay mesh position (OR 3.51), and associated enterotomy (OR 5.17).
Conclusions:
- Immunosuppressive drug use, urgent repair, and postoperative surgical site infection significantly predict mesh infection in AWHR.
- Polytetrafluoroethylene mesh, onlay mesh placement, and concurrent enterotomy are key risk factors for prosthesis explantation.
- These findings can inform surgical strategies to mitigate risks associated with AWHR.
