Incidence and Risk Factors of Long-term Mesh Explantation Due to Infection Following Hernia Surgery
*William J O'Brien1,2, *Radwan Dipp Ramos1, *Kalpana Gupta3, Kamal Itani1
1VA Boston Department of Surgery, Boston, MA;2VA Boston Center for Healthcare Organization and Implementation Research, Boston, MA;3VA Boston Department of Medicine, Boston, MA
Objective: Infections after hernia surgery are potentially disastrous, often requiring long-term antibiotics, debridement, re-operation, and mesh explantation. Our objective is to describe the long-term incidence and risk factors for mesh explantation due to infection in a large cohort.
Design: Retrospective cohort study using VASQIP registry data and medical record review. Setting: Veteran Health Administration inpatient and outpatient settings.
Patients: Veterans undergoing hernia repair with synthetic mesh implantation during calendar years 2008-2015.
Interventions: None.
Main Outcome Measures: Hernia mesh explantation due to infection, within 5 years of index surgery.
Results: The study population consisted of 96,442 hernia surgeries, of which 76,892 (79.7%) were inguinal, 11,117 (11.6%) umbilical, and 8,373 (8.7%) ventral. SSI incidence was highest in the ventral repairs (4.1%), followed by umbilical (1.9%) and inguinal (0.5%). We flagged 611 patients as having possible mesh explantation due to infection based on CPT codes. Of these, 358 (0.4% of the study population) were found to be true positives in medical record review. In multivariate logistic regression, mutable factors associated with increased explantation risk were body mass index (OR 4.33; 95% CI 2.35-7.97) and smoking (OR 1.24; 95% CI 1.00-1.59). ASA Classification of 3-5 was associated with 1.58 odds ratio of explantation (95% CI 1.20-2.09), as was longer duration of surgery (OR 1.42; 95% CI 1.18-1.71), contaminated (OR 3.10; 95% CI 1.32-7.30) and dirty (OR 3.57; 95% CI 1.24-10.29) surgical wound classification. Umbilical repair (OR 4.71; 95% CI 3.31-6.70) and ventral repair (OR 14.68; 95% CI 11.00-19.59) were associated with higher risk compared to inguinal repair.
Conclusions: Mesh explantation for infection is most common after ventral hernia repair. Risk factor optimization is critical to minimize such an outcome.
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