Variation in mesh placement for ventral hernia repair: an opportunity for process improvement?

Stephen H. Gray, Catherine C. Vick, Laura A. Graham, Kelly R. Finan, Leigh A Neumayer, Mary T. Hawn

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Incisional hernia repair (IHR) with mesh has been associated with decreased hernia recurrence. We analyzed variation in mesh use for IHR. Methods: A cohort undergoing IHR from 16 Veterans' Administration (VA) Hospitals was identified. Patient-specific variables were obtained from National Surgical Quality Improvement Program (NSQIP) data. Operative variables were obtained from physician-abstracted operative notes. Univariate and multivariable logistic regression analyses were used to model mesh implantation predictors. Results: A total of 1,123 IHR cases were analyzed; Mesh was implanted in 69.6% (n = 781). Regression models demonstrated repair at a high performing facility was associated with a nearly 4-fold increase in mesh utilization. Other significant predictors include repair of recurrent hernia, chronic steroid use, and multiple fascial defects. Conclusions: There is variation in the rate of mesh placement for IHR by VA facility, even after accounting for key explanatory variables. Patterns of mesh placement in IHR appear to be based on practice style.

Original languageEnglish (US)
Pages (from-to)201-206
Number of pages6
JournalAmerican Journal of Surgery
Volume196
Issue number2
DOIs
StatePublished - Aug 2008
Externally publishedYes

Fingerprint

Ventral Hernia
Herniorrhaphy
United States Department of Veterans Affairs
Veterans Hospitals
Hernia
Quality Improvement
Incisional Hernia
Logistic Models
Steroids
Regression Analysis
Physicians
Recurrence

Keywords

  • Incisional hernia repair
  • Quality
  • Variation

ASJC Scopus subject areas

  • Surgery

Cite this

Variation in mesh placement for ventral hernia repair : an opportunity for process improvement? / Gray, Stephen H.; Vick, Catherine C.; Graham, Laura A.; Finan, Kelly R.; Neumayer, Leigh A; Hawn, Mary T.

In: American Journal of Surgery, Vol. 196, No. 2, 08.2008, p. 201-206.

Research output: Contribution to journalArticle

Gray, Stephen H. ; Vick, Catherine C. ; Graham, Laura A. ; Finan, Kelly R. ; Neumayer, Leigh A ; Hawn, Mary T. / Variation in mesh placement for ventral hernia repair : an opportunity for process improvement?. In: American Journal of Surgery. 2008 ; Vol. 196, No. 2. pp. 201-206.
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