Remulla Daphne, Slatnick Brianna L, Woo Kimberly P, Bennett William C, Carvalho Alvaro, Tang Cammy, Miles Kimberly S, Huang Li-Ching, Miller Benjamin T, Beffa Lucas R, Krpata David M, Petro Clayton C, Prabhu Ajita S, Rosen Michael J
Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Hernia. 2025 Jul 9;29(1):226. doi: 10.1007/s10029-025-03405-9.
BACKGROUND: While mesh infection after ventral hernia repair often requires explantation and subsequent repair, the association between prior mesh infection with outcomes following complex abdominal wall reconstruction remains poorly understood. METHODS: A two-stage propensity score-matched analysis was performed using the Abdominal Core Health Quality Collaborative database. Patients undergoing clean, elective, open ventral hernia repair with prior mesh infections were compared with those with no prior wound morbidity and non-mesh-related surgical site infections (SSIs). All patients underwent elective open ventral hernia repair with transversus abdominis release (TAR) and retromuscular synthetic mesh placement. RESULTS: After propensity score matching, 205 patients with prior mesh infection were matched to 205 patients with prior non-mesh-related SSI and to 548 patients with no prior wound morbidity. Patients with a prior mesh infection experienced significantly higher rates of 30-day surgical site occurrences (SSO) (24.9% vs. 14.1%; p < 0.001) and surgical site occurrences requiring procedural intervention (14.1% vs. 7.7%; p = 0.007), compared with those with no prior wound morbidity. Compared with those with prior non-mesh-related SSIs, patients with a prior mesh infection also had a higher rate of SSO (25% vs. 14%; p = 0.004) and a higher proportion of deep SSIs (65% vs. 20%; p = 0.004). Despite these differences, mesh excision rates were low across all groups (0.1-0.2%). Patients with prior mesh infection reported significantly worse quality of life at baseline (median HerQLes: 22 vs. 32; p = 0.008) and worse pain scores at 30 days (median PROMIS 3 A: 52 vs. 46; p = 0.007). Reoperation and hernia recurrence rates were similar between groups throughout the five-year follow-up period. CONCLUSIONS: Prior mesh infection is associated with increased short-term wound morbidity following complex abdominal wall reconstruction, despite similar long-term hernia recurrence rates and low rates of mesh excision. While transversus abdominis release (TAR) with retromuscular mesh placement may mitigate the risk of repeated mesh infection and explantation, prior mesh infections impact patient outcomes well beyond the immediate postoperative period. These findings can help guide informed discussion and set appropriate patient expectations.
背景：虽然腹侧疝修补术后的补片感染通常需要取出补片并随后进行修复，但先前补片感染与复杂腹壁重建术后结果之间的关联仍知之甚少。 方法：使用腹部核心健康质量协作数据库进行两阶段倾向评分匹配分析。将接受过清洁、择期、开放性腹侧疝修补术且有先前补片感染的患者与那些没有先前伤口并发症和非补片相关手术部位感染（SSI）的患者进行比较。所有患者均接受了经腹横肌松解（TAR）和肌后放置合成补片的择期开放性腹侧疝修补术。 结果：经过倾向评分匹配后，205例有先前补片感染的患者与205例有先前非补片相关SSI的患者以及548例没有先前伤口并发症的患者相匹配。与没有先前伤口并发症的患者相比，有先前补片感染的患者30天手术部位事件（SSO）发生率显著更高（24.9%对14.1%；p<0.001），且需要进行手术干预的手术部位事件发生率也更高（14.1%对7.7%；p=0.007）。与有先前非补片相关SSI的患者相比，有先前补片感染的患者SSO发生率也更高（25%对14%；p=0.004），深部SSI的比例也更高（65%对20%；p=0.004）。尽管存在这些差异，但所有组的补片切除率都很低（0.1 - 0.2%）。有先前补片感染的患者在基线时报告的生活质量明显更差（HerQLes中位数：22对32；p=0.008），在30天时疼痛评分也更差（PROMIS 3A中位数：52对46；p=0.007）。在整个五年随访期内，各组之间的再次手术和疝复发率相似。 结论：尽管长期疝复发率相似且补片切除率较低，但先前补片感染与复杂腹壁重建术后短期伤口并发症增加有关。虽然经腹横肌松解（TAR）和肌后补片放置可能会降低补片反复感染和取出的风险，但先前的补片感染对患者结果的影响远不止于术后即刻。这些发现有助于指导知情讨论并设定适当的患者预期标准。
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