Suture, synthetic, or biologic in contaminated ventral hernia repair

Ventral Hernia Outcomes Collaborative

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

RESULTS: A total of 761 VHR were reviewed for a median (range) follow-up of 15 (1-50) mo: there were 291(38%) suture, 303 (40%) low-density and/or mid-density synthetic mesh, and 167(22%) biologic matrix repair. On univariate analysis, there were differences in the three groups including ethnicity, ASA, body mass index, institution, diabetes, primary versus incisional hernia, wound class, hernia size, prior VHR, fascial release, skin flaps, and acute repair. The unadjusted outcomes for SSI (15.1%; 17.8%; 21.0%; P = 0.280) and recurrence (17.8%; 13.5%; 21.5%; P = 0.074) were not statistically different between groups. On multivariate analysis, biologic matrix was associated with a nonsignificant reduction in both SSI and recurrences, whereas synthetic mesh associated with fewer recurrences compared to suture (hazard ratio = 0.60; P = 0.015) and nonsignificant increase in SSI.

CONCLUSIONS: Interval estimates favored biologic matrix repair in contaminated VHR; however, these results were not statistically significant. In the absence of higher level evidence, surgeons should carefully balance risk, cost, and benefits in managing contaminated ventral hernia repair.

BACKGROUND: Data are lacking to support the choice between suture, synthetic mesh, or biologic matrix in contaminated ventral hernia repair (VHR). We hypothesize that in contaminated VHR, suture repair is associated with the lowest rate of surgical site infection (SSI).

METHODS: A multicenter database of all open VHR performed at from 2010-2011 was reviewed. All patients with follow-up of 1 mo and longer were included. The primary outcome was SSI as defined by the Centers for Disease Control and Prevention. The secondary outcome was hernia recurrence (assessed clinically or radiographically). Multivariate analysis (stepwise regression for SSI and Cox proportional hazard model for recurrence) was performed.

Original languageEnglish (US)
Pages (from-to)488-494
Number of pages7
JournalThe Journal of surgical research
Volume200
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Ventral Hernia
Herniorrhaphy
Surgical Wound Infection
Sutures
Recurrence
Hernia
Multivariate Analysis
Centers for Disease Control and Prevention (U.S.)
Proportional Hazards Models
Cost-Benefit Analysis
Body Mass Index
Databases
Skin
Wounds and Injuries

Keywords

  • Clean contaminated
  • Contaminated
  • Hernia repair
  • Mesh
  • Umbilical hernia
  • Ventral hernia

ASJC Scopus subject areas

  • Surgery

Cite this

Suture, synthetic, or biologic in contaminated ventral hernia repair. / Ventral Hernia Outcomes Collaborative.

In: The Journal of surgical research, Vol. 200, No. 2, 01.02.2016, p. 488-494.

Research output: Contribution to journalArticle

Ventral Hernia Outcomes Collaborative. / Suture, synthetic, or biologic in contaminated ventral hernia repair. In: The Journal of surgical research. 2016 ; Vol. 200, No. 2. pp. 488-494.
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abstract = "RESULTS: A total of 761 VHR were reviewed for a median (range) follow-up of 15 (1-50) mo: there were 291(38{\%}) suture, 303 (40{\%}) low-density and/or mid-density synthetic mesh, and 167(22{\%}) biologic matrix repair. On univariate analysis, there were differences in the three groups including ethnicity, ASA, body mass index, institution, diabetes, primary versus incisional hernia, wound class, hernia size, prior VHR, fascial release, skin flaps, and acute repair. The unadjusted outcomes for SSI (15.1{\%}; 17.8{\%}; 21.0{\%}; P = 0.280) and recurrence (17.8{\%}; 13.5{\%}; 21.5{\%}; P = 0.074) were not statistically different between groups. On multivariate analysis, biologic matrix was associated with a nonsignificant reduction in both SSI and recurrences, whereas synthetic mesh associated with fewer recurrences compared to suture (hazard ratio = 0.60; P = 0.015) and nonsignificant increase in SSI.CONCLUSIONS: Interval estimates favored biologic matrix repair in contaminated VHR; however, these results were not statistically significant. In the absence of higher level evidence, surgeons should carefully balance risk, cost, and benefits in managing contaminated ventral hernia repair.BACKGROUND: Data are lacking to support the choice between suture, synthetic mesh, or biologic matrix in contaminated ventral hernia repair (VHR). We hypothesize that in contaminated VHR, suture repair is associated with the lowest rate of surgical site infection (SSI).METHODS: A multicenter database of all open VHR performed at from 2010-2011 was reviewed. All patients with follow-up of 1 mo and longer were included. The primary outcome was SSI as defined by the Centers for Disease Control and Prevention. The secondary outcome was hernia recurrence (assessed clinically or radiographically). Multivariate analysis (stepwise regression for SSI and Cox proportional hazard model for recurrence) was performed.",
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author = "{Ventral Hernia Outcomes Collaborative} and Bondre, {Ioana L.} and Holihan, {Julie L.} and Askenasy, {Erik P.} and Greenberg, {Jacob A.} and Keith, {Jerrod N.} and Robert Martindale and Roth, {J. Scott} and Liang, {Mike K.}",
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AU - Ventral Hernia Outcomes Collaborative

AU - Bondre, Ioana L.

AU - Holihan, Julie L.

AU - Askenasy, Erik P.

AU - Greenberg, Jacob A.

AU - Keith, Jerrod N.

AU - Martindale, Robert

AU - Roth, J. Scott

AU - Liang, Mike K.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - RESULTS: A total of 761 VHR were reviewed for a median (range) follow-up of 15 (1-50) mo: there were 291(38%) suture, 303 (40%) low-density and/or mid-density synthetic mesh, and 167(22%) biologic matrix repair. On univariate analysis, there were differences in the three groups including ethnicity, ASA, body mass index, institution, diabetes, primary versus incisional hernia, wound class, hernia size, prior VHR, fascial release, skin flaps, and acute repair. The unadjusted outcomes for SSI (15.1%; 17.8%; 21.0%; P = 0.280) and recurrence (17.8%; 13.5%; 21.5%; P = 0.074) were not statistically different between groups. On multivariate analysis, biologic matrix was associated with a nonsignificant reduction in both SSI and recurrences, whereas synthetic mesh associated with fewer recurrences compared to suture (hazard ratio = 0.60; P = 0.015) and nonsignificant increase in SSI.CONCLUSIONS: Interval estimates favored biologic matrix repair in contaminated VHR; however, these results were not statistically significant. In the absence of higher level evidence, surgeons should carefully balance risk, cost, and benefits in managing contaminated ventral hernia repair.BACKGROUND: Data are lacking to support the choice between suture, synthetic mesh, or biologic matrix in contaminated ventral hernia repair (VHR). We hypothesize that in contaminated VHR, suture repair is associated with the lowest rate of surgical site infection (SSI).METHODS: A multicenter database of all open VHR performed at from 2010-2011 was reviewed. All patients with follow-up of 1 mo and longer were included. The primary outcome was SSI as defined by the Centers for Disease Control and Prevention. The secondary outcome was hernia recurrence (assessed clinically or radiographically). Multivariate analysis (stepwise regression for SSI and Cox proportional hazard model for recurrence) was performed.

AB - RESULTS: A total of 761 VHR were reviewed for a median (range) follow-up of 15 (1-50) mo: there were 291(38%) suture, 303 (40%) low-density and/or mid-density synthetic mesh, and 167(22%) biologic matrix repair. On univariate analysis, there were differences in the three groups including ethnicity, ASA, body mass index, institution, diabetes, primary versus incisional hernia, wound class, hernia size, prior VHR, fascial release, skin flaps, and acute repair. The unadjusted outcomes for SSI (15.1%; 17.8%; 21.0%; P = 0.280) and recurrence (17.8%; 13.5%; 21.5%; P = 0.074) were not statistically different between groups. On multivariate analysis, biologic matrix was associated with a nonsignificant reduction in both SSI and recurrences, whereas synthetic mesh associated with fewer recurrences compared to suture (hazard ratio = 0.60; P = 0.015) and nonsignificant increase in SSI.CONCLUSIONS: Interval estimates favored biologic matrix repair in contaminated VHR; however, these results were not statistically significant. In the absence of higher level evidence, surgeons should carefully balance risk, cost, and benefits in managing contaminated ventral hernia repair.BACKGROUND: Data are lacking to support the choice between suture, synthetic mesh, or biologic matrix in contaminated ventral hernia repair (VHR). We hypothesize that in contaminated VHR, suture repair is associated with the lowest rate of surgical site infection (SSI).METHODS: A multicenter database of all open VHR performed at from 2010-2011 was reviewed. All patients with follow-up of 1 mo and longer were included. The primary outcome was SSI as defined by the Centers for Disease Control and Prevention. The secondary outcome was hernia recurrence (assessed clinically or radiographically). Multivariate analysis (stepwise regression for SSI and Cox proportional hazard model for recurrence) was performed.

KW - Clean contaminated

KW - Contaminated

KW - Hernia repair

KW - Mesh

KW - Umbilical hernia

KW - Ventral hernia

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