Risk-adjusted adverse outcomes in complex abdominal wall hernia repair with biologic mesh: A case series of 140 patients

Rifat - Latifi, David Samson, Ansab Haider, Asad Azim, Hajira Iftikhar, Bellal A Joseph, Elizabeth Tilley, Jorge Con, Saranda Gashi, Ayman El-Menyar

Research output: Contribution to journalArticle

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Abstract

Introduction Biologic mesh is preferred for repair of complex abdominal wall hernias (CAWHs) in patients at high risk of wound infection. We aimed to identify predictors of adverse outcomes after complex abdominal wall hernia repair (CAWR) using biologic mesh with different placement techniques and under different surgical settings. Methods A retrospective case series study was conducted on all patients who underwent CAWR with biologic mesh between 2010 and 2015 at a tertiary medical center. Results: the study population included 140 patients with a mean age of 54 ± 14 years and a median follow up period 8.8 months. Mesh size ranged from 50 to 1225 cm2. Ninety percent of patients had undergone previous surgery. Type of surgery was classified as elective in 50.7%, urgent in 24.3% and emergent in 25.0% and a porcine mesh was implanted in 82.9%. The most common mesh placement technique was underlay (70.7%), followed by onlay (16.4%) and bridge (12.9%). Complications included wound complications (30.7%), reoperation (25.9%), hernia recurrence (20.7%), and mesh removal (10.0%). Thirty-two patients (23.0%) were admitted to the ICU and the mean hospital length of stay was 10.8 ± 17.5 days. Age-sex adjusted predictors of recurrence were COPD (OR 4.2; 95%CI 1.003–17.867) and urgent surgery (OR 10.5; 95%CI 1.856–59.469), whereas for reoperation, mesh size (OR 6.8; 95%CI 1.344–34.495) and urgent surgery (OR 5.2; 95%CI 1.353–19.723) were the predictors. Conclusions Using biologic mesh, one-quarter and one-fifth of CAWR patients are complicated with reoperation or recurrence, respectively. The operation settings and comorbidity may play a role in these outcomes regardless of the mesh placement techniques.

Original languageEnglish (US)
Pages (from-to)26-32
Number of pages7
JournalInternational Journal of Surgery
Volume43
DOIs
StatePublished - Jul 1 2017

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Abdominal Hernia
Herniorrhaphy
Abdominal Wall
Reoperation
Recurrence
Length of Stay
Inlays
Wound Infection
Hernia
Chronic Obstructive Pulmonary Disease
Comorbidity
Swine
Wounds and Injuries
Population

Keywords

  • Abdominal wall defect
  • Biologic mesh
  • Hernia repair
  • Outcomes
  • Techniques

ASJC Scopus subject areas

  • Surgery

Cite this

Risk-adjusted adverse outcomes in complex abdominal wall hernia repair with biologic mesh : A case series of 140 patients. / Latifi, Rifat -; Samson, David; Haider, Ansab; Azim, Asad; Iftikhar, Hajira; Joseph, Bellal A; Tilley, Elizabeth; Con, Jorge; Gashi, Saranda; El-Menyar, Ayman.

In: International Journal of Surgery, Vol. 43, 01.07.2017, p. 26-32.

Research output: Contribution to journalArticle

Latifi, Rifat - ; Samson, David ; Haider, Ansab ; Azim, Asad ; Iftikhar, Hajira ; Joseph, Bellal A ; Tilley, Elizabeth ; Con, Jorge ; Gashi, Saranda ; El-Menyar, Ayman. / Risk-adjusted adverse outcomes in complex abdominal wall hernia repair with biologic mesh : A case series of 140 patients. In: International Journal of Surgery. 2017 ; Vol. 43. pp. 26-32.
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abstract = "Introduction Biologic mesh is preferred for repair of complex abdominal wall hernias (CAWHs) in patients at high risk of wound infection. We aimed to identify predictors of adverse outcomes after complex abdominal wall hernia repair (CAWR) using biologic mesh with different placement techniques and under different surgical settings. Methods A retrospective case series study was conducted on all patients who underwent CAWR with biologic mesh between 2010 and 2015 at a tertiary medical center. Results: the study population included 140 patients with a mean age of 54 ± 14 years and a median follow up period 8.8 months. Mesh size ranged from 50 to 1225 cm2. Ninety percent of patients had undergone previous surgery. Type of surgery was classified as elective in 50.7{\%}, urgent in 24.3{\%} and emergent in 25.0{\%} and a porcine mesh was implanted in 82.9{\%}. The most common mesh placement technique was underlay (70.7{\%}), followed by onlay (16.4{\%}) and bridge (12.9{\%}). Complications included wound complications (30.7{\%}), reoperation (25.9{\%}), hernia recurrence (20.7{\%}), and mesh removal (10.0{\%}). Thirty-two patients (23.0{\%}) were admitted to the ICU and the mean hospital length of stay was 10.8 ± 17.5 days. Age-sex adjusted predictors of recurrence were COPD (OR 4.2; 95{\%}CI 1.003–17.867) and urgent surgery (OR 10.5; 95{\%}CI 1.856–59.469), whereas for reoperation, mesh size (OR 6.8; 95{\%}CI 1.344–34.495) and urgent surgery (OR 5.2; 95{\%}CI 1.353–19.723) were the predictors. Conclusions Using biologic mesh, one-quarter and one-fifth of CAWR patients are complicated with reoperation or recurrence, respectively. The operation settings and comorbidity may play a role in these outcomes regardless of the mesh placement techniques.",
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T2 - A case series of 140 patients

AU - Latifi, Rifat -

AU - Samson, David

AU - Haider, Ansab

AU - Azim, Asad

AU - Iftikhar, Hajira

AU - Joseph, Bellal A

AU - Tilley, Elizabeth

AU - Con, Jorge

AU - Gashi, Saranda

AU - El-Menyar, Ayman

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N2 - Introduction Biologic mesh is preferred for repair of complex abdominal wall hernias (CAWHs) in patients at high risk of wound infection. We aimed to identify predictors of adverse outcomes after complex abdominal wall hernia repair (CAWR) using biologic mesh with different placement techniques and under different surgical settings. Methods A retrospective case series study was conducted on all patients who underwent CAWR with biologic mesh between 2010 and 2015 at a tertiary medical center. Results: the study population included 140 patients with a mean age of 54 ± 14 years and a median follow up period 8.8 months. Mesh size ranged from 50 to 1225 cm2. Ninety percent of patients had undergone previous surgery. Type of surgery was classified as elective in 50.7%, urgent in 24.3% and emergent in 25.0% and a porcine mesh was implanted in 82.9%. The most common mesh placement technique was underlay (70.7%), followed by onlay (16.4%) and bridge (12.9%). Complications included wound complications (30.7%), reoperation (25.9%), hernia recurrence (20.7%), and mesh removal (10.0%). Thirty-two patients (23.0%) were admitted to the ICU and the mean hospital length of stay was 10.8 ± 17.5 days. Age-sex adjusted predictors of recurrence were COPD (OR 4.2; 95%CI 1.003–17.867) and urgent surgery (OR 10.5; 95%CI 1.856–59.469), whereas for reoperation, mesh size (OR 6.8; 95%CI 1.344–34.495) and urgent surgery (OR 5.2; 95%CI 1.353–19.723) were the predictors. Conclusions Using biologic mesh, one-quarter and one-fifth of CAWR patients are complicated with reoperation or recurrence, respectively. The operation settings and comorbidity may play a role in these outcomes regardless of the mesh placement techniques.

AB - Introduction Biologic mesh is preferred for repair of complex abdominal wall hernias (CAWHs) in patients at high risk of wound infection. We aimed to identify predictors of adverse outcomes after complex abdominal wall hernia repair (CAWR) using biologic mesh with different placement techniques and under different surgical settings. Methods A retrospective case series study was conducted on all patients who underwent CAWR with biologic mesh between 2010 and 2015 at a tertiary medical center. Results: the study population included 140 patients with a mean age of 54 ± 14 years and a median follow up period 8.8 months. Mesh size ranged from 50 to 1225 cm2. Ninety percent of patients had undergone previous surgery. Type of surgery was classified as elective in 50.7%, urgent in 24.3% and emergent in 25.0% and a porcine mesh was implanted in 82.9%. The most common mesh placement technique was underlay (70.7%), followed by onlay (16.4%) and bridge (12.9%). Complications included wound complications (30.7%), reoperation (25.9%), hernia recurrence (20.7%), and mesh removal (10.0%). Thirty-two patients (23.0%) were admitted to the ICU and the mean hospital length of stay was 10.8 ± 17.5 days. Age-sex adjusted predictors of recurrence were COPD (OR 4.2; 95%CI 1.003–17.867) and urgent surgery (OR 10.5; 95%CI 1.856–59.469), whereas for reoperation, mesh size (OR 6.8; 95%CI 1.344–34.495) and urgent surgery (OR 5.2; 95%CI 1.353–19.723) were the predictors. Conclusions Using biologic mesh, one-quarter and one-fifth of CAWR patients are complicated with reoperation or recurrence, respectively. The operation settings and comorbidity may play a role in these outcomes regardless of the mesh placement techniques.

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KW - Hernia repair

KW - Outcomes

KW - Techniques

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