Sahoo Sambit, Haskins Ivy N, Huang Li-Ching, Krpata David M, Derwin Kathleen A, Poulose Benjamin K, Rosen Michael J
Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, OH Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN The Vanderbilt Hernia Center, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
J Am Coll Surg. 2017 Oct;225(4):472-480e1. doi: 10.1016/j.jamcollsurg.2017.07.1067. Epub 2017 Aug 4.
Recently introduced slow-resorbing biosynthetic and non-resorbing macroporous polypropylene meshes are being used in hernias with clean-contaminated and contaminated wounds. However, information about the use of biosynthetic meshes and their outcomes compared with polypropylene meshes in clean-contaminated and contaminated cases is lacking. Here we evaluate the use of biosynthetic mesh and polypropylene mesh in elective open ventral hernia repair (OVHR) and investigate differences in early wound morbidity after OVHR within clean-contaminated and contaminated cases.
All elective, OVHR with biosynthetic mesh or uncoated polypropylene mesh from January 2013 through October 2016 were identified within the Americas Hernia Society Quality Collaborative. Association of mesh type with 30-day wound events in clean-contaminated or contaminated wounds was investigated using a 1:3 propensity-matched analysis.
Biosynthetic meshes were used in 8.5% (175 of 2,051) of elective OVHR, with the majority (57.1%) used in low-risk or comorbid clean cases. Propensity-matched analysis in clean-contaminated and contaminated cases showed no significant difference between biosynthetic mesh and polypropylene mesh groups for 30-day surgical site occurrences (20.7% vs 16.7%; p = 0.49) or unplanned readmission (13.8% vs 9.8%; p = 0.4). However, surgical site infections (22.4% vs 10.9%; p = 0.03), surgical site occurrences requiring procedural intervention (24.1% vs 13.2%; p = 0.049), and reoperation rates (13.8% vs 4.0%; p = 0.009) were significantly higher in the biosynthetic group.
Biosynthetic mesh appears to have higher rates of 30-day wound morbidity compared with polypropylene mesh in elective OVHR with clean-contaminated or contaminated wounds. Additional post-market analysis is needed to provide evidence defining best mesh choices, location, and surgical technique for repairing contaminated ventral hernias.
最近引入的可缓慢吸收的生物合成和不可吸收的大孔聚丙烯补片正用于清洁-污染和污染伤口的疝修补。然而，在清洁-污染和污染病例中，与聚丙烯补片相比，关于生物合成补片的使用及其结果的信息尚缺。在此，我们评估生物合成补片和聚丙烯补片在择期开放性腹疝修补术（OVHR）中的应用，并研究在清洁-污染和污染病例中OVHR术后早期伤口并发症的差异。
在美洲疝学会质量协作组中确定了2013年1月至2016年10月期间所有使用生物合成补片或未涂层聚丙烯补片的择期OVHR。使用1:3倾向匹配分析研究补片类型与清洁-污染或污染伤口中30天伤口事件的相关性。
在择期OVHR中，8.5%（2051例中的175例）使用了生物合成补片，其中大多数（57.1%）用于低风险或合并症的清洁病例。在清洁-污染和污染病例中的倾向匹配分析显示，生物合成补片组和聚丙烯补片组在30天手术部位事件（20.7%对16.7%；p = 0.49）或非计划再入院（13.8%对9.8%；p = 0.4）方面无显著差异。然而，生物合成补片组的手术部位感染（22.4%对10.9%；p = 0.03）、需要进行手术干预的手术部位事件（24.1%对13.2%；p = 0.049）和再次手术率（13.8%对4.0%；p = 0.009）显著更高。
在有清洁-污染或污染伤口的择期OVHR中，与聚丙烯补片相比，生物合成补片的30天伤口并发症发生率似乎更高。需要进行更多的上市后分析，以提供证据来确定修复污染性腹疝的最佳补片选择、位置和手术技术。
