학술논문
A western trauma association multicenter comparison of mesh versus non-mesh repair of blunt traumatic abdominal wall hernias.
Document Type
Academic Journal
Author
Harrell KN; University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, United States. Electronic address: kevinharrell830@gmail.com.; Grimes AD; University of Oklahoma, Oklahoma City, OK, United States.; Gill H; University of Oklahoma, Oklahoma City, OK, United States.; Reynolds JK; University of Kentucky School of Medicine, Lexington, KY, United States.; Ueland WR; University of Kentucky School of Medicine, Lexington, KY, United States.; Sciarretta JD; Grady Health System, Atlanta, GA, United States.; Todd SR; Grady Health System, Atlanta, GA, United States.; Trust MD; University of Texas at Austin, Austin, TX, United States.; Ngoue M; University of Texas at Austin, Austin, TX, United States.; Thomas BW; Atrium Health Carolinas Medical Center, Charlotte, NC, United States.; Ayuso SA; Atrium Health Carolinas Medical Center, Charlotte, NC, United States.; LaRiccia A; Grant Medical Center, Columbus, OH, United States.; Spalding MC; Grant Medical Center, Columbus, OH, United States.; Collins MJ; Carillion Clinic, Roanoke, VA, United States.; Collier BR; Carillion Clinic, Roanoke, VA, United States.; Karam BS; Medical College of Wisconsin, Milwaukee, WI, United States.; de Moya MA; Medical College of Wisconsin, Milwaukee, WI, United States.; Lieser MJ; Research Medical Center, Kansas City, MO, United States.; Chipko JM Jr; Research Medical Center, Kansas City, MO, United States.; Haan JM; Ascension Via Christi on St. Francis Hospital, Wichita, KS, United States.; Lightwine KL; Ascension Via Christi on St. Francis Hospital, Wichita, KS, United States.; Cullinane DC; Maine Medical Center, Portland, ME, United States.; Falank CR; Maine Medical Center, Portland, ME, United States.; Phillips RC; Denver Health Medical Center, Denver, CO, United States.; Kemp MT; University of Michigan, Ann Arbor, MI, United States.; Alam HB; University of Michigan, Ann Arbor, MI, United States.; Udekwu PO; WakeMed Health, Raleigh, NC, United States.; Sanin GD; Wake Forest School of Medicine, Winston-Salem, NC, United States.; Hildreth AN; Wake Forest School of Medicine, Winston-Salem, NC, United States.; Biffl WL; Scripps Memorial Hospital La Jolla, La Jolla, CA, United States.; Schaffer KB; Scripps Memorial Hospital La Jolla, La Jolla, CA, United States.; Marshall G; Medical City Plano Hospital, Plano, TX, United States.; Muttalib O; University of California, Irvine, Orange, CA, United States.; Nahmias J; University of California, Irvine, Orange, CA, United States.; Shahi N; Children's Hospital Colorado, Denver, CO, United States.; Moulton SL; Children's Hospital Colorado, Denver, CO, United States.; Maxwell RA; University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, United States.
Source
Publisher: Elsevier Country of Publication: Netherlands NLM ID: 0226040 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0267 (Electronic) Linking ISSN: 00201383 NLM ISO Abbreviation: Injury Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Blunt traumatic abdominal wall hernias (TAWH) occur in <1 % of trauma patients. Optimal repair techniques, such as mesh reinforcement, have not been studied in detail. We hypothesize that mesh use will be associated with increased surgical site infections (SSI) and not improve hernia recurrence.
Materials and Methods: A secondary analysis of the Western Trauma Association blunt TAWH multicenter study was performed. Patients who underwent TAWH repair during initial hospitalization (1/2012-12/2018) were included. Mesh repair patients were compared to primary repair patients (non-mesh). A logistic regression was conducted to assess risk factors for SSI.
Results: 157 patients underwent TAWH repair during index hospitalization with 51 (32.5 %) having mesh repair: 24 (45.3 %) synthetic and 29 (54.7 %) biologic. Mesh patients were more commonly smokers (43.1 % vs. 22.9 %, p = 0.016) and had a larger defect size (10 vs. 6 cm, p = 0.003). Mesh patients had a higher rate of SSI (25.5 % vs. 9.5 %, p = 0.016) compared to non-mesh patients, but a similar rate of recurrence (13.7 % vs. 10.5%, p = 0.742), hospital length of stay (LOS), and mortality. Mesh use (OR 3.66) and higher ISS (OR 1.06) were significant risk factors for SSI in a multivariable model.
Conclusion: Mesh was used more frequently in flank TAWH and those with a larger defect size. Mesh use was associated with a higher incidence and risk of SSI but did not reduce the risk of hernia recurrence. When repairing TAWH mesh should be employed judiciously, and prospective randomized studies are needed to identify clear indications for mesh use in TAWH.
Competing Interests: Declaration of Competing Interest The authors have no conflicts to report
(Copyright © 2023. Published by Elsevier Ltd.)
Materials and Methods: A secondary analysis of the Western Trauma Association blunt TAWH multicenter study was performed. Patients who underwent TAWH repair during initial hospitalization (1/2012-12/2018) were included. Mesh repair patients were compared to primary repair patients (non-mesh). A logistic regression was conducted to assess risk factors for SSI.
Results: 157 patients underwent TAWH repair during index hospitalization with 51 (32.5 %) having mesh repair: 24 (45.3 %) synthetic and 29 (54.7 %) biologic. Mesh patients were more commonly smokers (43.1 % vs. 22.9 %, p = 0.016) and had a larger defect size (10 vs. 6 cm, p = 0.003). Mesh patients had a higher rate of SSI (25.5 % vs. 9.5 %, p = 0.016) compared to non-mesh patients, but a similar rate of recurrence (13.7 % vs. 10.5%, p = 0.742), hospital length of stay (LOS), and mortality. Mesh use (OR 3.66) and higher ISS (OR 1.06) were significant risk factors for SSI in a multivariable model.
Conclusion: Mesh was used more frequently in flank TAWH and those with a larger defect size. Mesh use was associated with a higher incidence and risk of SSI but did not reduce the risk of hernia recurrence. When repairing TAWH mesh should be employed judiciously, and prospective randomized studies are needed to identify clear indications for mesh use in TAWH.
Competing Interests: Declaration of Competing Interest The authors have no conflicts to report
(Copyright © 2023. Published by Elsevier Ltd.)