Department of Surgery, Boston, MA.
Department of Surgery, Boston, MA; Center for Organization and Implementation Research, Boston, MA.
J Am Coll Surg. 2021 Jun;232(6):872-880.e2. doi: 10.1016/j.jamcollsurg.2020.12.064. Epub 2021 Feb 15.
Infectious complications after hernia operation are potentially disastrous, often requiring long-term antibiotic administration, debridement, and mesh explantation. Our objective was to describe the long-term incidence and risk factors for synthetic mesh explantation due to infection after hernia operation in a large cohort.
Retrospective database study using Veterans Affairs Surgical Quality Improvement Program and chart review of veterans undergoing abdominal or groin hernia repair with synthetic mesh implantation during 2008-2015. The main outcome was mesh explantation due to infection within 5 years.
The study population consisted of 103,869 hernia operations, of which 74.3% were inguinal, 10.7% umbilical, and 15.0% ventral. Explantation incidence was highest among ventral (1.5%). Median explantation interval overall was 208 days. In multivariable logistic regression, all obesity levels from pre-obesity to obesity class III were associated with higher explantation risk. American Society of Anesthesiology physical status classification of 3 to 5 was associated with odds ratio (OR) of 1.7 (95% CI, 1.28 to 2.26), as was longer operative duration (OR 1.83; 95% CI, 1.51 to 2.21), and contaminated or dirty surgical wound classification (OR 2.27; 95% CI, 1.11 to 4.64). Umbilical repair (OR 6.11; 95% CI, 4.14 to 9.02) and ventral repair (OR 14.35; 95% CI, 10.39 to 19.82) were associated with higher risk compared with inguinal. Open repair was associated with a higher risk compared with laparoscopic (OR 3.57; 95% CI, 2.52 to 5.05). Deep incisional surgical site infection within 30 days of operation was more likely to result in long-term mesh explantation (29.2%) than either superficial (6.4%) or organ space infection (22.4%).
Mesh explantation for infection is most common after ventral hernia repair. Risk factor optimization is crucial to minimize such an end point.
疝手术后的感染并发症可能是灾难性的，通常需要长期使用抗生素、清创和网片取出。我们的目的是在一个大样本中描述疝手术后因感染而导致合成网片取出的长期发生率和危险因素。
利用退伍军人事务部手术质量改进计划和对 2008-2015 年期间接受腹部或腹股沟疝修补术并植入合成网片的退伍军人的图表回顾进行回顾性数据库研究。主要结局是 5 年内因感染而导致网片取出。
研究人群包括 103869 例疝手术，其中 74.3%为腹股沟疝，10.7%为脐疝，15.0%为腹疝。腹疝的取出发生率最高（1.5%）。总体中位数取出间隔为 208 天。在多变量逻辑回归中，从超重到肥胖 III 级的所有肥胖水平都与更高的取出风险相关。美国麻醉医师协会身体状况分类 3 至 5 与优势比（OR）1.7（95%可信区间，1.28 至 2.26）相关，手术时间较长（OR 1.83；95%可信区间，1.51 至 2.21）和污染或脏手术伤口分类（OR 2.27；95%可信区间，1.11 至 4.64）也是如此。与腹股沟疝相比，脐疝修复（OR 6.11；95%可信区间，4.14 至 9.02）和腹疝修复（OR 14.35；95%可信区间，10.39 至 19.82）的风险更高。与腹腔镜相比，开放修复与更高的风险相关（OR 3.57；95%可信区间，2.52 至 5.05）。术后 30 天内深部切口手术部位感染更有可能导致长期网片取出（29.2%），而浅部（6.4%）或器官间隙感染（22.4%）则不然。
感染后网片取出最常见于腹疝修复。优化危险因素对于最大限度地减少这种结局至关重要。
