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Updated: Sep 4, 2025
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Hospital-level variation in mesh use for ventral and incisional hernia repair
Ryan Howard1,2, Anne Ehlers1,2, Lia Delaney3
1Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Background:
Placement of prosthetic mesh during ventral and incisional hernia repair has been shown to reduce the incidence of postoperative hernia recurrence. Consequently, multiple consensus guidelines recommend the use of mesh for ventral hernias of any size. However, the extent to which real-world practice patterns reflect these recommendations is unclear.
Methods:
We performed a retrospective review of the Michigan Surgical Quality Collaborative Hernia Registry (MSQC-HR) to identify patients undergoing clean ventral or incisional hernia repair between January 1, 2020 and December 31, 2021. The primary outcome was mesh use. We used two-step hierarchical logistic regression modeling with empirical Bayes estimates to evaluate the association of hospital-level mesh use with patient, operative, and hernia characteristics.
Results:
A total of 5262 patients underwent ventral and incisional hernia repair at 65 hospitals with a mean age of 53.8 (14.5) years, 2292 (43.6%) females, and a mean hernia width of 3.2 (3.4) cm. Mean hospital volume was 81 (49) cases. Mesh was used in 4098 (77.9%) patients. At the patient level, hernia width and surgical approach were significantly associated with mesh use. Specifically, mesh use was 6.2% (95% CI 4.8-7.5%) more likely with each additional centimeter of hernia width and 28.0% (95% CI 26.1-29.8%) more likely for minimally invasive repair compared to open repair. At the hospital level, there was wide variation in mesh use, ranging from 38.0% (95% CI 31.5-44.9%) to 96.4% (95% CI 95.3-97.2%). Hospital-level mesh use was not associated with differences in hernia size (β = - 0.003, P = 0.978), surgical approach (β = - 1.109, P = 0.414), or any other patient factors.
Conclusions:
Despite strong evidence supporting the use of mesh in ventral and incisional hernia repair, there is substantial variation in mesh use between hospitals that is not explained by differences in patient characteristics or operative approach. This suggests that opportunities exist to standardize surgical practice to better align with evidence supporting the use of mesh in the management of these hernias.
Insights
Despite guidelines recommending mesh for ventral hernia repair, real-world use varies significantly between hospitals. This variation is not linked to patient or surgical factors, indicating a need for practice standardization to improve hernia management.
Area of Science:
- Surgical quality improvement
- Hernia surgery outcomes
- Prosthetic mesh utilization
Background:
- Prosthetic mesh placement in ventral and incisional hernia repair reduces recurrence.
- Guidelines strongly recommend mesh for all ventral hernia sizes.
- Real-world adherence to mesh recommendations is not well understood.
Purpose of the Study:
- To assess mesh utilization patterns in ventral and incisional hernia repair.
- To identify factors associated with mesh use at patient and hospital levels.
- To evaluate variations in mesh use across different hospitals.
Main Methods:
- Retrospective review of the Michigan Surgical Quality Collaborative Hernia Registry (MSQC-HR).
- Analysis of 5262 clean ventral or incisional hernia repairs from January 2020 to December 2021.
- Two-step hierarchical logistic regression to model mesh use association with patient, operative, and hospital factors.
Main Results:
- Mesh was used in 77.9% of 5262 hernia repairs across 65 hospitals.
- Mesh use increased with hernia width and was higher for minimally invasive repairs.
- Significant hospital-level variation in mesh use (38.0% to 96.4%) was observed, unexplained by patient or operative factors.
Conclusions:
- Substantial unexplained variation in mesh use exists between hospitals for ventral and incisional hernia repair.
- Current practice patterns do not fully align with evidence-based guidelines for mesh use.
- Opportunities exist to standardize surgical practices to improve mesh utilization in hernia repair.
