Complex abdominal wall hernia repair with biologic mesh in elderly: a propensity matched analysis

Area of Science:

• Surgical Innovation
• Geriatric Surgery
• Biomaterials in Medicine

Background:

• Complex abdominal wall reconstruction (CAWR) is increasingly performed in both elderly and non-elderly patient populations.
• The safety and efficacy of CAWR in elderly individuals compared to younger counterparts require thorough investigation.

Purpose of the Study:

• To compare the outcomes of elderly versus non-elderly patients undergoing CAWR.
• To evaluate the effectiveness of porcine-derived, non-crosslinked acellular dermal matrix (ADM) in CAWR across different age groups.

Main Methods:

• Retrospective analysis of 136 patients who underwent CAWR using Strattice™ (porcine ADM) between 2014 and 2017.
• Propensity score matching was employed for risk adjustment and one-to-one matching to compare elderly (≥65 years) and non-elderly (18-64 years) cohorts.
• Outcomes assessed included postoperative complications, reoperations, mortality, hospital length of stay, and discharge disposition.

Main Results:

• After propensity score matching (35 pairs), no significant differences were observed in surgical site infection, wound necrosis, or need for mechanical ventilation.
• Mortality rates, reoperation rates, hospital length of stay, and discharge disposition were also similar between the elderly and non-elderly groups.
• The study included 70% non-elderly and 30% elderly patients, with 56.7% females.

Conclusions:

• Elderly patients undergoing CAWR with biological mesh (porcine ADM) demonstrate comparable outcomes to non-elderly patients.
• Propensity score matching is a valuable tool for risk adjustment, enabling fair comparison of surgical outcomes across age groups.
• These findings support the use of biological mesh in CAWR for elderly patients.