Biologic mesh in ventral hernia repair: Outcomes, recurrence, and charge analysis

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• 作者：Ciara R. Huntington ; MD ; Tiffany C. Cox ; MD ; Laurel J. Blair ; MD ; Samuel Schell ; BS ; David Randolph ; BS ; Tanushree Prasad ; MA ; Amy Lincourt ; PhD ; MBA ; B. Todd Heniford ; MD ; FACS ; Vedra A. Augenstein ; MD ; FACS ; ^{Vedra.augenstein@carolinas.org" class="auth_mail" title="E-mail the corresponding author}
• 刊名：Surgery
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：160
• 期：6
• 页码：1517-1527
• 全文大小：167 K

文摘

Biologic mesh choice in ventral hernia repair is challenging due to lack of prospective data. This study examines long-term, single-center biologic mesh outcomes.

bsSec_2">Methods

bspara0015">Prospective operative outcomes data was queried for open ventral hernia repair with biologic mesh. Univariate and multivariate analysis were used to compare mesh outcomes.

bsSec_3">Results

bspara0020">In the study, 223 patients underwent open ventral hernia repair with biologic mesh, including 40 with Alloderm, 23 AlloMax, 70 FlexHD, 68 Strattice, and 22 Xenmatrix. Overall, 9.8% had an American Society of Anesthesiology classification of 4, 54.6% with a classification of 3, and 35.6% with a classification of 1 or 2. Operative time averaged 241 minutes with estimated blood loss of 202 mL. Hernia defects averaged 257 ± 245 cm² with mesh size 384 cm². Biologic mesh was used as a fascial bridge in 19.6%, component separation was performed in 47.5%, and 82% had concomitant procedure. Inpatient mortality was 1.4%. Hernia recurrence varied significantly by mesh type: 35% Alloderm, 34.5% AlloMax, 37.1% FlexHD, 14.7% Strattice, and 59.1% Xenmatrix (P = .001). The mean follow-up was 18.2 months. After multivariate analysis comparing to Strattice, AlloMax had a 3.4 higher odds ratio for recurrence, FlexHD a 2.9 odds ratio, and Xenmatrix a 7.8 odds ratio. The rate of mesh infections requiring explantation was <1%. Total hospital charges averaged $131,004 ± $143,320. Mean charges varied significantly between meshes; Xenmatrix was the most expensive and AlloMax was the least expensive (P < .05).

bsSec_4">Conclusion

bspara0025">In 223 ventral hernia repair performed with biologic mesh at a tertiary care institution, Strattice, a porcine acellular dermal mesh, had significantly lower odds of hernia recurrence compared with AlloMax, FlexHD, and Xenmatrix. Choice of biologic mesh affects long-term postoperative outcomes in ventral hernia repair.