Lorenz William R, Holland Alexis M, Kerr Samantha W, Ayuso Sully A, Polcz Monica E, Scarola Gregory T, Kercher Kent W, Heniford B Todd, Augenstein Vedra A
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC.
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC.
Surgery. 2025 Mar;179:108795. doi: 10.1016/j.surg.2024.06.055. Epub 2024 Sep 20.
The choice of biologic compared with synthetic mesh in abdominal wall reconstruction remains controversial, especially in Centers for Disease Control and Prevention class 1 and 2 wounds. This study evaluated wound complications and hernia recurrence with a 2:1 propensity-matched sample and extended follow-up.
A prospectively maintained abdominal wall reconstruction database was queried for patients undergoing open abdominal wall reconstruction using biologic or synthetic mesh in Centers for Disease Control and Prevention class 1 and 2 wounds. Patients receiving synthetic or biologic mesh were propensity score matched in a 2:1 fashion. Univariate, bivariate, and inferential analyses were conducted. Unless stated, data are reported as biologic compared with synthetic.
In total, 519 patients were compared, 173 with biologic and 346 with synthetic mesh. Defect size (215.2 ± 153.6 cm vs 251.5 ± 284.3 cm), body mass index (33.6 ± 9 kg/m vs 34 ±17.7 kg/m), and comorbidities were well matched (all P > .05). Although Centers for Disease Control and Prevention wound class was used in the match, it was significantly different between groups (Centers for Disease Control and Prevention 1:43.4% vs 81.2%, Centers for Disease Control and Prevention 2:56.6% vs 18.8%; P < .001). The rate of component separation (40.1% vs 44.2%; P = .397), fascial closure (97.7% vs 98.3%; P = .738), and panniculectomy (33.5% vs 29.2%; P = .315) were similar. Mesh size was also similar (816.4 ± 555.5 vs 892.2 ± 487.8 cm; P = .112). Wound complications were equal, including wound breakdown (10.5% vs 7.5%; P = .315), wound cellulitis (5.2% vs 5.8%; P = .843), wound infection (7.5% vs 4.6%; P = .223), seroma requiring intervention (6.4% vs 7.8%; P = .597), and mesh infection (1.2% vs 0.9%; P > .999). The biologic group had an increased length of stay (6.8 ± 5.5 days vs 5.4 ± 2.3 days; P < .001) and greater hospital charges ($82,181 ± 50,356 vs $62,221 ± 26,817 USD; P < .001). Mean follow-up after biologic repair was longer (33.9 ± 36.6 months vs 23.3 ± 32.3 months; P < .001). Hernia recurrence between the biologic and synthetic groups was not significantly different (2.9% vs 1.4%; P = .313). On multivariable regression, wound complications were predictive of recurrence, and panniculectomy was predictive of wound complications.
In a 2:1 matched analysis of Centers for Disease Control and Prevention 1 and 2 wounds with nearly 3-years of follow-up, biologic and synthetic mesh had similar rates of wound complications and recurrence in abdominal wall reconstruction.
在腹壁重建中，生物补片与合成补片的选择仍存在争议，尤其是在疾病控制与预防中心（Centers for Disease Control and Prevention，CDC）分类为1级和2级的伤口中。本研究通过2:1倾向评分匹配样本和延长随访时间，评估了伤口并发症和疝复发情况。
查询前瞻性维护的腹壁重建数据库，以获取在CDC 1级和2级伤口中使用生物补片或合成补片进行开放性腹壁重建的患者。接受合成补片或生物补片的患者按2:1的方式进行倾向评分匹配。进行了单变量、双变量和推断性分析。除非另有说明，数据报告为生物补片与合成补片的对比情况。
总共比较了519例患者，其中173例使用生物补片，346例使用合成补片。缺损大小（215.2±153.6平方厘米对251.5±284.3平方厘米）、体重指数（33.6±9千克/平方米对34±17.7千克/平方米）和合并症情况匹配良好（所有P>.05）。尽管在匹配过程中使用了CDC伤口分类，但两组之间存在显著差异（CDC 1级：43.4%对81.2%，CDC 2级：56.6%对18.8%；P<.001）。组织分离率（40.1%对44.2%；P=.397）、筋膜闭合率（97.7%对98.3%；P=.738）和腹壁成形术（33.5%对29.2%；P=.315）相似。补片大小也相似（816.4±555.5平方厘米对892.2±487.8平方厘米；P=.112）。伤口并发症情况相当，包括伤口裂开（10.5%对7.5%；P=.315）、伤口蜂窝织炎（5.2%对5.8%；P=.843）、伤口感染（7.5%对4.6%；P=.223）、需要干预的血清肿（6.4%对7.8%；P=.597）和补片感染（1.2%对0.9%；P>.999）。生物补片组的住院时间延长（6.8±5.5天对5.4±2.3天；P<.001），住院费用更高（82,181±50,356美元对62,221±26,817美元；P<.001）。生物补片修复后的平均随访时间更长（33.9±36.6个月对23.3±32.3个月；P<.001）。生物补片组和合成补片组之间疝复发无显著差异（2.9%对1.4%；P=.313）。在多变量回归分析中，伤口并发症可预测复发，腹壁成形术可预测伤口并发症。
在对CDC 1级和2级伤口进行的2:1匹配分析中，经过近3年的随访，生物补片和合成补片在腹壁重建中的伤口并发症和复发率相似。
