The Use of Mesh in Emergent Ventral Hernia Repair and its Effect on Early Patient Morbidity and Mortality

Ivy N Haskins, MD, Richard Amdur, PhD, Khashayar Vaziri, MD, FACS. Department of Surgery, The George Washington University

Introduction: The long-term recurrence rate of ventral hernia repair (VHR) is estimated to be 20%-50%, with a higher rate of recurrence in cases that do not use mesh. Previous teachings have discouraged the use of mesh in clean-contaminated, contaminated, or dirty cases. Translated into general practice, emergent VHR is often performed without the use of mesh. We  seek to determine if the use of mesh in emergent VHR is an independent risk factor for early patient morbidity and mortality using the National Surgery Quality Improvement Program (NSQIP) database.

Methods: All emergency VHRs were identified within the NSQIP database from 2005-2013. The effect of mesh on post-operative morbidity and mortality was investigated for all wound classes using between-groups t-test, chi-square regression, and multivariate logistic regression. A mesh-wound class interaction term and a NSQIP-specific frailty index were incorporated. Significance was defined as p<0.05.

Results: A total of 2,449 patients underwent emergent VHR from 2005-2013. The use of mesh was associated with a significantly longer operative time for all wound classes and increased risk of return to the operating room in contaminated cases. Upon further review, however, no patient in the contaminated cases cohort who returned to the operating room underwent revision of their VHR or explantation of mesh.

Conclusions: Emergency VHR with mesh can be performed without increased postoperative morbidity and mortality despite an increased operative time. Future studies should investigate the effect of synthetic and biologic mesh utilization on emergency VHR outcomes.             

Table I: Effect of Mesh on Return to the Operating Room, Stratified by Wound Class
Wound Class

Mesh Effect

(Odds Ratio, 95% CI)

2: Clean/Contaminated

(n=1357)

0.91 (0.55-1.52)
3: Contaminated (n=587) 2.89 (1.57-5.31)**
4: Dirty (n=505) 1.44 (0.83-2.48)

 ** p<0.01

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