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Early Patient Morbidity after Open Ventral Hernia Repair with Permanent Synthetic vs Biosynthetic Mesh
Vol. 223, No. 4S2, October 2016
Scientific Forum: 2016 Clinical Congress
(c-statistic 0.74), with scores of 0, 7, and 15 correlating with complication rates of 13.1%, 57.5% and 93%, respectively, then plateauing for scores above 15. Sensitivity analyses demonstrated that ESAS effectively predicts mortality in patients undergoing emergent spleni, gastroduodenal, intestinal, hepatobiliary, or incarcerated ventral hernia (Table). Table. Sensitivity Analysis Based on CPT Codes Demonstrating the C-Statistic Evaluation of ESAS in Specific Subgroups of EL
CPT code Splenic surgery Gastroduodenal surgery Intestinal surgery Hepatobiliary surgery Ventral hernia
Observations, n 196 1,836 19,892 739 1,695
Mortality, % 9.69 11.50 9.80 5.68 2.30
C-statistic, receiver operating characteristic 0.81 0.80 0.83 0.84 0.79
CONCLUSIONS: ESAS accurately predicts outcomes in all types of EL patients and may prove valuable as a bedside decision making tool for patient and family counseling, as well as for adequate risk adjustment in EL quality benchmarking efforts. Early Patient Morbidity after Open Ventral Hernia Repair with Permanent Synthetic vs Biosynthetic Mesh Sambit Sahoo, MD, PhD, Ivy N Haskins, MD, Colin O’Rourke, David Krpata, MD, Kathleen Derwin, PhD, Michael J Rosen, MD, FACS Cleveland Clinic, Cleveland, OH INTRODUCTION: Biosynthetic slow-resorbable meshes (ie, Bio-A, Phasix, and TIGR-Matrix) are being increasingly used in ventral hernia repair (VHR). However, it is unclear if they have advantages over permanent synthetic meshes in clean-contaminated and contaminated cases. The objective of this study was to evaluate early patient wound morbidity between biosynthetic (BS) and polypropylene synthetic (PS) meshes. METHODS: A retrospective review was conducted using the AHSQC (Americas Hernia Society Quality Collaborative) database of all elective, open VHRs that used either PS or BS mesh from
Table. Effect of Biosynthetic Mesh Utilization on 30-Day Patient Outcomes Outcome
SSI SSO SSOPI Length of stay Readmission
Odds ratio
95% CI
p Value
2.02 1.39 1.85 1.19 2.64
0.80-5.06 0.58-3.34 0.79-4.36 0.85-1.69 0.93-7.49
0.14 0.47 0.16 0.31 0.07
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2013 through 2015. Patients with CDC wound classes II and III were identified and matched based on key demographic and intraoperative variables. Propensity score weights were created and statistical models incorporating these weights were fit using R version 3.2.3. Testing was two-sided with significance p<0.05. RESULTS: A total of 328 patients met inclusion criteria; 288 had VHR with PS while 40 had VHR with BS (BioA, Phasix). In terms of 30-day outcomes, there was no statistically significant difference in terms of wound-related morbidity, including surgical site infection (SSI), surgical site occurrences (SSO), or SSO requiring procedural intervention (SSOPI) between patients who underwent VHR with PS vs those who underwent VHR with BS in these two wound classes (Table). CONCLUSIONS: After appropriate matching, there appears to be no benefit to the use of biosynthetic mesh over synthetic mesh in clean-contaminated or contaminated cases in the short term. Additional studies are needed to determine if there is a difference between these mesh types, such as hernia recurrence, over the long term.
Impact of Clipping vs No Hair Removal on Surgical Site Infections: A Prospective, Randomized Trial Shanu N Kothari, MD, FACS, Andrew J Borgert, PhD, Todd J Kowalski, MD Gundersen Health System, Gundersen Medical Foundation, La Crosse, WI INTRODUCTION: Surgical site infections (SSIs) remain the most common health care-associated infection, but the impact of removing hair at the surgical site on the rate of SSIs remains largely unanswered. METHODS: We conducted a prospective, randomized, noninferiority clinical trial (ClinicalTrials.gov ID: NCT00975377) in patients 18 years of age and older undergoing elective general surgical procedures in a single center from October 2009 to February 2015. The primary endpoint was the proportion of patients who could be evaluated and for whom there was no SSI of any type, as defined by CDC criteria, at a follow-up visit approximately 2 weeks after surgery. Secondary endpoints were the development of specific types of SSI (superficial, deep, and organ space). RESULTS: Baseline demographic, clinical, and surgical characteristics were similar between groups. A total of 1,678 patients were randomized to the Clipped (n¼834) or Not Clipped (n¼844) group and included in the modified intention-to-treat analysis. Of the randomized patients, 1,543 (768 in the Clipped group and 775 in the Not Clipped group) were included in the per-protocol analysis. The overall rate of SSI was 6.12% (47/768) in the Clipped group and 6.32% (49/775) in the Not Clipped group (absolute difference, -0.20%; 95% CI, -2.61/ -2.21), p¼0.037. CONCLUSIONS: Patients who did not have hair clipped preoperatively (as recommended by the CDC) had an infection rate similar
Scientific Forum: 2016 Clinical Congress
(c-statistic 0.74), with scores of 0, 7, and 15 correlating with complication rates of 13.1%, 57.5% and 93%, respectively, then plateauing for scores above 15. Sensitivity analyses demonstrated that ESAS effectively predicts mortality in patients undergoing emergent spleni, gastroduodenal, intestinal, hepatobiliary, or incarcerated ventral hernia (Table). Table. Sensitivity Analysis Based on CPT Codes Demonstrating the C-Statistic Evaluation of ESAS in Specific Subgroups of EL
CPT code Splenic surgery Gastroduodenal surgery Intestinal surgery Hepatobiliary surgery Ventral hernia
Observations, n 196 1,836 19,892 739 1,695
Mortality, % 9.69 11.50 9.80 5.68 2.30
C-statistic, receiver operating characteristic 0.81 0.80 0.83 0.84 0.79
CONCLUSIONS: ESAS accurately predicts outcomes in all types of EL patients and may prove valuable as a bedside decision making tool for patient and family counseling, as well as for adequate risk adjustment in EL quality benchmarking efforts. Early Patient Morbidity after Open Ventral Hernia Repair with Permanent Synthetic vs Biosynthetic Mesh Sambit Sahoo, MD, PhD, Ivy N Haskins, MD, Colin O’Rourke, David Krpata, MD, Kathleen Derwin, PhD, Michael J Rosen, MD, FACS Cleveland Clinic, Cleveland, OH INTRODUCTION: Biosynthetic slow-resorbable meshes (ie, Bio-A, Phasix, and TIGR-Matrix) are being increasingly used in ventral hernia repair (VHR). However, it is unclear if they have advantages over permanent synthetic meshes in clean-contaminated and contaminated cases. The objective of this study was to evaluate early patient wound morbidity between biosynthetic (BS) and polypropylene synthetic (PS) meshes. METHODS: A retrospective review was conducted using the AHSQC (Americas Hernia Society Quality Collaborative) database of all elective, open VHRs that used either PS or BS mesh from
Table. Effect of Biosynthetic Mesh Utilization on 30-Day Patient Outcomes Outcome
SSI SSO SSOPI Length of stay Readmission
Odds ratio
95% CI
p Value
2.02 1.39 1.85 1.19 2.64
0.80-5.06 0.58-3.34 0.79-4.36 0.85-1.69 0.93-7.49
0.14 0.47 0.16 0.31 0.07
e19
2013 through 2015. Patients with CDC wound classes II and III were identified and matched based on key demographic and intraoperative variables. Propensity score weights were created and statistical models incorporating these weights were fit using R version 3.2.3. Testing was two-sided with significance p<0.05. RESULTS: A total of 328 patients met inclusion criteria; 288 had VHR with PS while 40 had VHR with BS (BioA, Phasix). In terms of 30-day outcomes, there was no statistically significant difference in terms of wound-related morbidity, including surgical site infection (SSI), surgical site occurrences (SSO), or SSO requiring procedural intervention (SSOPI) between patients who underwent VHR with PS vs those who underwent VHR with BS in these two wound classes (Table). CONCLUSIONS: After appropriate matching, there appears to be no benefit to the use of biosynthetic mesh over synthetic mesh in clean-contaminated or contaminated cases in the short term. Additional studies are needed to determine if there is a difference between these mesh types, such as hernia recurrence, over the long term.
Impact of Clipping vs No Hair Removal on Surgical Site Infections: A Prospective, Randomized Trial Shanu N Kothari, MD, FACS, Andrew J Borgert, PhD, Todd J Kowalski, MD Gundersen Health System, Gundersen Medical Foundation, La Crosse, WI INTRODUCTION: Surgical site infections (SSIs) remain the most common health care-associated infection, but the impact of removing hair at the surgical site on the rate of SSIs remains largely unanswered. METHODS: We conducted a prospective, randomized, noninferiority clinical trial (ClinicalTrials.gov ID: NCT00975377) in patients 18 years of age and older undergoing elective general surgical procedures in a single center from October 2009 to February 2015. The primary endpoint was the proportion of patients who could be evaluated and for whom there was no SSI of any type, as defined by CDC criteria, at a follow-up visit approximately 2 weeks after surgery. Secondary endpoints were the development of specific types of SSI (superficial, deep, and organ space). RESULTS: Baseline demographic, clinical, and surgical characteristics were similar between groups. A total of 1,678 patients were randomized to the Clipped (n¼834) or Not Clipped (n¼844) group and included in the modified intention-to-treat analysis. Of the randomized patients, 1,543 (768 in the Clipped group and 775 in the Not Clipped group) were included in the per-protocol analysis. The overall rate of SSI was 6.12% (47/768) in the Clipped group and 6.32% (49/775) in the Not Clipped group (absolute difference, -0.20%; 95% CI, -2.61/ -2.21), p¼0.037. CONCLUSIONS: Patients who did not have hair clipped preoperatively (as recommended by the CDC) had an infection rate similar