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Coated Polypropylene Mesh Is Not an Independent Predictor of Wound Morbidity in Open Abdominal Wall Reconstruction
Samantha W Kerr1, Victoria L Walker2, Lucy R Hinton3
1Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Abstract:
BackgroundBarrier-coated meshes were developed to minimize adhesion formation between the PM and adjacent viscera. However, prior data has shown an increased infectious risk associated with rapidly absorbable coated PM vs uncoated PM in open preperitoneal AWR (OPPAWR). This study evaluated differences in wound and mesh infection rates between coated and uncoated PM in patients undergoing OPPAWR.Materials and MethodsA prospectively maintained, tertiary hernia center database was queried for patients undergoing OPPAWR with PM in CDC class 1/2 wounds. Using 1:1 propensity-score matching (PSM), coated and uncoated groups were matched on factors known to influence outcomes. Multivariable regression models determined independent predictors of wound and infectious complications.ResultsOf 1450 patients with coated and uncoated PM, 382 pairs were well-matched. Propensity-score matching covariates were similar (all P > 0.05). The coated group had higher rates of wound infection (6.3% vs 3.1%), postoperative IV antibiotics (8.6% vs 4.7%), percutaneous drain placement (6.8% vs 3.1%), and mesh infection (2.4% vs 0.0%) (all P < 0.05), but no significant difference in composite wound complications (20.4% vs 16.5%; P = 0.162). Multivariable regression showed panniculectomy (OR: 1.87, 95% CI: 1.25-2.82; P = 0.003) and BMI (OR: 1.05, 95% CI: 1.02-1.08; P = 0.002) were independent predictors of wound complications, but coated mesh was not (OR: 0.78, 95% CI: 0.53-1.15; P = 0.211). In the infectious model regression, panniculectomy remained an independent predictor (OR: 2.01, 95% CI: 1.24-3.25; P = 0.005), while coated mesh again was not (OR: 0.65, 95% CI: 0.41-1.04; P = 0.074).DiscussionIn the largest reported cohort, following complex OPPAWR, multivariable regression demonstrated that coated PM did not independently predict wound or infectious complications.
Insights
Barrier-coated meshes did not increase wound or infectious complications in patients undergoing open preperitoneal abdominal wall reconstruction (OPPAWR). This study found no independent link between coated mesh and adverse outcomes in complex cases.
Area of Science:
- Surgical Innovation and Materials Science
- Hernia Repair and Abdominal Wall Reconstruction
- Infectious Disease and Surgical Outcomes
Background:
- Barrier-coated meshes aim to reduce adhesions between prosthetic material (PM) and viscera.
- Previous studies suggested a potential increase in infectious risk with rapidly absorbable coated PM versus uncoated PM in open preperitoneal abdominal wall reconstruction (OPPAWR).
Purpose of the Study:
- To evaluate and compare wound and mesh infection rates between coated and uncoated PM in patients undergoing OPPAWR.
- To identify independent predictors of wound and infectious complications in this patient population.
Main Methods:
- A prospectively maintained database from a tertiary hernia center was queried for patients undergoing OPPAWR with PM in clean/contaminated wounds (CDC class 1/2).
- 1:1 propensity-score matching (PSM) was used to create comparable groups of patients receiving coated versus uncoated PM, matching on known outcome-influencing factors.
- Multivariable regression models were employed to determine independent predictors of wound and infectious complications.
Main Results:
- Out of 1450 patients, 382 matched pairs (coated vs. uncoated PM) were analyzed.
- The coated mesh group exhibited higher rates of wound infection (6.3% vs. 3.1%), postoperative IV antibiotic use (8.6% vs. 4.7%), and mesh infection (2.4% vs. 0.0%) (all P < 0.05).
- Multivariable regression analysis indicated that panniculectomy and BMI were independent predictors of wound complications, while coated mesh was not identified as an independent predictor (OR: 0.78, 95% CI: 0.53-1.15; P = 0.211). Similarly, coated mesh was not an independent predictor of infectious complications (OR: 0.65, 95% CI: 0.41-1.04; P = 0.074).
Conclusions:
- In the largest reported cohort for complex OPPAWR, barrier-coated meshes did not independently predict an increased risk of wound or infectious complications.
- Factors such as panniculectomy and higher BMI were identified as significant independent predictors of complications.
- The findings suggest that coated meshes can be safely used in complex OPPAWR without a statistically significant independent increase in infectious or wound complications.
