Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
J Am Coll Surg. 2021 Dec;233(6):676-684. doi: 10.1016/j.jamcollsurg.2021.08.679. Epub 2021 Sep 13.
Patients with contaminated/dirty-infected defects are at high risk for postoperative complications after abdominal wall reconstruction (AWR). We evaluated outcomes of AWR using acellular dermal matrix (ADM) for mesh reinforcement and identified predictors of hernia recurrence (HR), surgical site occurrences (SSOs), and surgical site infections (SSIs).
We conducted a retrospective cohort study of patients who underwent AWR using ADM, from March 2005 to June 2019. Outcomes were compared between Centers for Disease Control and Prevention (CDC) wound classifications. The primary outcome measure was HR. Secondary outcomes were SSOs and SSIs.
We identified 725 AWRs using ADM that met the study criteria. Participants had a mean age of 60 ± 11.5 years, mean BMI of 31 ± 7 kg/m, and mean follow-up time of 42 ± 29 months. Three hundred two patients (41.6%) had clean defects, 322 patients (44.4%) had clean-contaminated defects, and 101 patients (13.9%) had contaminated/dirty-infected defects. Patients with contaminated/dirty-infected defects had an HR rate of 20.8%, SSO rate of 54.5%, and SSI rate of 23.8%. Multivariate logistic regression found that contaminated/dirty-infected defects were independent predictors of SSOs (OR 2.99; 95% CI 1.72-5.18; p < 0.0001) and SSIs (OR 2.32; 95% CI 1.27-4.25; p = 0.006), but not HR (OR 1.06; 95% CI 0.57-1.98; p = 0.859).
SSIs and SSOs increase as contamination levels rise, but the risk of HR does not. AWR with ADM provides safe and durable outcomes, even with increasing levels of contamination.
腹部壁重建 (AWR) 后，污染/感染缺陷的患者术后并发症风险较高。我们评估了使用脱细胞真皮基质 (ADM) 进行网片加固的 AWR 结果，并确定了疝复发 (HR)、手术部位发生 (SSO) 和手术部位感染 (SSI) 的预测因素。
我们对 2005 年 3 月至 2019 年 6 月期间使用 ADM 进行 AWR 的患者进行了回顾性队列研究。结果在疾病预防控制中心 (CDC) 伤口分类之间进行了比较。主要观察指标是 HR。次要结果是 SSO 和 SSI。
我们确定了符合研究标准的 725 例使用 ADM 的 AWR。参与者的平均年龄为 60 ± 11.5 岁，平均 BMI 为 31 ± 7 kg/m，平均随访时间为 42 ± 29 个月。302 例患者 (41.6%) 为清洁缺陷，322 例患者 (44.4%) 为清洁污染缺陷，101 例患者 (13.9%) 为污染/感染缺陷。污染/感染缺陷患者的 HR 率为 20.8%，SSO 率为 54.5%，SSI 率为 23.8%。多变量逻辑回归发现，污染/感染缺陷是 SSO (OR 2.99;95%CI 1.72-5.18;p<0.0001) 和 SSI (OR 2.32;95%CI 1.27-4.25;p=0.006) 的独立预测因素，但不是 HR (OR 1.06;95%CI 0.57-1.98;p=0.859)。
随着污染程度的增加，SSI 和 SSO 增加，但 HR 的风险没有增加。即使污染程度增加，ADM 进行 AWR 也能提供安全且持久的结果。
