Martinez Ugarte Stephanie, Fajemisin Mokunfayo O, Guy-Frank Chelsea J, Ferguson Dalya M, Stulberg Jonah J, Kao Lillian S, Holihan Julie L
Department of Surgery, Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas; Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
J Surg Res. 2025 Jul;311:212-220. doi: 10.1016/j.jss.2025.04.028. Epub 2025 May 28.
Patients' perceptions about synthetic mesh for ventral hernia repair (VHR) may stem from a lack of knowledge of risks. We assessed patients' threshold for accepting the risk of hernia recurrence to avoid synthetic mesh.
Patients ≥18 y old with prior or upcoming VHR viewed a one-time video decision aid describing recurrence risk with biologic versus synthetic mesh. Patients chose between these options using a probability trade-off (PTO) technique, varying hernia recurrence rate with biologic mesh. Based on randomized trials, the recurrence rate using synthetic mesh was 9%. The PTO score was the recurrence rate (0%-100%) at which patients would no longer choose biologic mesh. The process was repeated, including expected wound complications with each mesh. Linear regression identified factors associated with higher PTO scores (risk aversion to synthetic mesh).
Of 100 patients, 57% always preferred synthetic mesh, 3% accepted a higher recurrence risk to have synthetic mesh, and 24% preferred biologic mesh but only if the recurrence rate was lower than with synthetic mesh. In addition, 15% accepted a higher recurrence risk to have biologic mesh, and 1% always preferred biologic mesh despite a higher hernia recurrence rate. Information on wound complications had little impact on mesh choice. On multivariable analysis, higher education and postoperative interviews were associated with higher PTO thresholds.
Contrary to the common belief that patients prefer to avoid synthetic mesh, this study showed that most patients prioritized reducing hernia recurrence risk over mesh type. Further studies should identify patient's goals and priorities for outcomes following VHR.
患者对用于腹疝修补术（VHR）的合成补片的看法可能源于对风险缺乏了解。我们评估了患者为避免使用合成补片而接受疝复发风险的阈值。
年龄≥18岁且有过或即将接受VHR的患者观看了一个一次性的视频决策辅助工具，该工具描述了生物补片与合成补片的复发风险。患者使用概率权衡（PTO）技术在这些选项之间进行选择，改变生物补片的疝复发率。根据随机试验，使用合成补片的复发率为9%。PTO评分是患者不再选择生物补片时的复发率（0%-100%）。重复该过程，包括每种补片预期的伤口并发症。线性回归确定了与较高PTO评分（对合成补片的风险厌恶）相关的因素。
在100名患者中，57%总是更喜欢合成补片，3%为了使用合成补片而接受更高的复发风险，24%更喜欢生物补片，但前提是复发率低于合成补片。此外，15%为了使用生物补片而接受更高的复发风险，1%尽管疝复发率较高但总是更喜欢生物补片。关于伤口并发症的信息对补片选择影响不大。在多变量分析中，高等教育程度和术后访谈与较高的PTO阈值相关。
与患者倾向于避免使用合成补片的普遍看法相反，本研究表明，大多数患者将降低疝复发风险置于补片类型之上。进一步的研究应确定患者在VHR后对结局的目标和优先事项。
