Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus.
Department of Population Health Sciences, Weill Cornell Medicine, New York, New York.
JAMA Surg. 2024 Jun 1;159(6):651-658. doi: 10.1001/jamasurg.2024.0233.
Recurrence is one of the most challenging adverse events after ventral hernia repair as it impacts quality of life, utilization of resources, and subsequent need for re-repair. Rates of recurrence range from 30% to 80% after ventral hernia repair.
To determine the contemporary ventral hernia recurrence rate over time in patients with previous hernia repair and to determine risk factors associated with recurrence.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based study used the Abdominal Core Health Quality Collaborative registry to evaluate year-over-year recurrence rates in patients with prior ventral hernia repair between January 2012 and August 2022. Patients who underwent at least 1 prior ventral hernia repair were included and categorized into 2 groups based on mesh or no-mesh use. There were 43 960 eligible patients; after exclusion criteria (patients with concurrent inguinal hernias as the primary diagnosis, nonstandard hernia procedure categories, American Society of Anesthesiologists class unassigned, or no follow-up), 29 834 patients were analyzed in the mesh group and 5599 in the no-mesh group.
Ventral hernia recurrence rates. Risk factors analyzed include age, body mass index, sex, race, insurance type, medical comorbidities, American Society of Anesthesiologists class, smoking, indication for surgery, concomitant procedure, hernia procedure type, myofascial release, fascial closure, fixation type, number of prior repairs, hernia width, hernia length, mesh width, mesh length, operative approach, prior mesh placement, prior mesh infection, mesh location, mesh type, postoperative surgical site occurrence, postoperative surgical site infection, postoperative seroma, use of drains, and reoperation.
Among 29 834 patients with mesh, the mean (SD) age was 57.17 (13.36) years, and 14 331 participants (48.0%) were female. Among 5599 patients without mesh, the mean (SD) age was 51.9 (15.31) years, and 2458 participants (43.9%) were female. When comparing year-over-year hernia recurrence rates in patients with and without prior mesh repair, respectively, the Kaplan Meier analysis showed a recurrence rate of 201 cumulative events with 13 872 at risk (2.8%) vs 104 cumulative events with 1707 at risk (4.0%) at 6 months; 411 cumulative events with 4732 at risk (8.0%) vs 184 cumulative events with 427 at risk (32.6%) at 1 year; 640 cumulative events with 1518 at risk (19.7%) vs 243 cumulative events with 146 at risk (52.4%) at 2 years; 731 cumulative events with 670 at risk (29.3%) vs 258 cumulative events with 73 at risk (61.4%) at 3 years; 777 cumulative events with 337 at risk (38.5%) vs 267 cumulative events with 29 at risk (71.2%) at 4 years; and 798 cumulative events with 171 at risk (44.9%) vs 269 cumulative events with 19 at risk (73.7%) at 5 years. Higher body mass index; immunosuppressants; incisional and parastomal hernias; a robotic approach; greater hernia width; use of a biologic or resorbable synthetic mesh; and complications, such as surgical site infections and reoperation, were associated with higher odds of hernia recurrence. Conversely, greater mesh width, myofascial release, and fascial closure had lower odds of recurrence. Hernia type was the most important variable associated with recurrence.
In this study, the 5-year recurrence rate after ventral hernia repair was greater than 40% and 70% in patients with and without mesh, respectively. Rates of ventral hernia recurrence increased over time, underscoring the importance of close, long-term follow up in this population.
腹疝修补术后复发是最具挑战性的不良事件之一，因为它会影响生活质量、资源利用以及随后再次修复的需要。腹疝修补术后复发率为 30%至 80%。
确定既往疝修补术后患者腹疝复发的当代复发率，并确定与复发相关的风险因素。
设计、地点和参与者：这项回顾性、基于人群的研究使用腹部核心健康质量协作登记处，评估 2012 年 1 月至 2022 年 8 月期间既往腹疝修补术后患者逐年复发率。纳入至少有 1 次既往腹疝修补术的患者，并根据使用网片或不使用网片将患者分为两组。共纳入 43960 例符合条件的患者；排除标准为（同期腹股沟疝为主要诊断、非标准疝手术类别、美国麻醉医师协会分类未指定或无随访）后，29834 例患者纳入网片组，5599 例患者纳入无网片组。
腹疝复发率。分析的风险因素包括年龄、体重指数、性别、种族、保险类型、合并症、美国麻醉医师协会分类、吸烟、手术指征、同时进行的手术、疝手术类型、筋膜松解术、筋膜闭合术、固定类型、既往修复次数、疝宽度、疝长度、网片宽度、网片长度、手术入路、既往网片放置、既往网片感染、网片位置、网片类型、术后手术部位并发症、术后手术部位感染、术后血清肿、引流管使用和再次手术。
在 29834 例网片组患者中，平均（SD）年龄为 57.17（13.36）岁，14331 例（48.0%）为女性。在 5599 例无网片组患者中，平均（SD）年龄为 51.9（15.31）岁，2458 例（43.9%）为女性。分别比较有和无既往网片修补术患者的年复发性疝发生率，Kaplan-Meier 分析显示，在 6 个月时，分别有 13872 例（2.8%）和 1707 例（4.0%）患者有 201 例累计事件和 104 例累计事件发生复发；在 1 年时，分别有 4732 例（8.0%）和 427 例（32.6%）患者有 411 例累计事件和 184 例累计事件发生复发；在 2 年时，分别有 1518 例（19.7%）和 427 例（52.4%）患者有 640 例累计事件和 243 例累计事件发生复发；在 3 年时，分别有 670 例（29.3%）和 427 例（61.4%）患者有 731 例累计事件和 258 例累计事件发生复发；在 4 年时，分别有 337 例（38.5%）和 427 例（71.2%）患者有 777 例累计事件和 267 例累计事件发生复发；在 5 年时，分别有 171 例（44.9%）和 427 例（73.7%）患者有 798 例累计事件和 269 例累计事件发生复发。更高的体重指数；免疫抑制剂；切口疝和造口旁疝；机器人手术方法；更大的疝宽度；使用生物或可吸收合成网片；以及手术部位感染和再次手术等并发症与更高的疝复发几率相关。相反，更大的网片宽度、筋膜松解术和筋膜闭合术降低了复发的几率。疝类型是与复发最相关的最重要变量。
在这项研究中，腹疝修补术后 5 年复发率在有网片和无网片的患者中分别大于 40%和 70%。腹疝复发率随时间增加，突出了在该人群中进行密切、长期随访的重要性。
