背景:中重(40-60g/m2)聚丙烯(MWPP)网片已被证明在CDCII-III级后肌腹侧疝修复(RMVHR)中是安全有效的。然而,MWPP有可能断裂,在这种情况下,重量级(>75g/m2)聚丙烯网可能具有类似的结果。然而,在清洁污染和污染的情况下,关于HWPP网格性能的数据有限。我们旨在比较开放式RMVHR期间CDCII-III级伤口中的HWPP与MWPP网状物。
方法:回顾性查询了腹部核心健康质量协作数据库中的一组患者,这些患者接受了2012年至2023年在CDCII/III级伤口中放置了MWPP或HWPP网状物的开放式RMVHR。使用3:1倾向评分匹配分析比较网格类型。匹配的协变量包括CDC分类,BMI,糖尿病,1年内吸烟,疝气,和网格宽度。感兴趣的主要结果包括伤口并发症。次要结果包括30天的再手术和再入院。
结果:共有1496例患者接受MWPP或HWPP(1378例与118,分别)在受污染的RMVHR中。在倾向得分匹配后,351名患者保持中等体重,117名患者保持体重。手术部位感染(SSI)率无显著差异(13.4%vs.14.5%,p=0.877),包括深度SSIs(0.3%与0%,p=1),手术部位发生率(17.9%vs.22.2%,p=0.377),需要手术干预的手术部位(16%vs.17.9%,p=0.719),网格去除(0.3%与0%,p=1),重新手术(4.6%与2.6%,p=0.428),或再入院(12.3%与9.4%,p=0.504),30天。
结论:HWPP网片与伤口发病率增加无关,网格切除,重新操作,在CDCII/III病例的开放RMVHR中,与MWPP网状物相比,术后早期再入院或再入院。需要进行更长时间的随访,以确定在受污染的情况下,HWPP网是否可以替代MWPP网。
BACKGROUND: Mediumweight (40-60 g/m2) polypropylene (MWPP) mesh has been shown to be safe and effective in CDC class II-III retromuscular ventral hernia repairs (RMVHR). However, MWPP has the potential to fracture, and it is possible that heavyweight (> 75 g/m2) polypropylene mesh has similar outcomes in this context. However, there is limited data on HWPP mesh performance in clean-contaminated and contaminated scenarios. We aimed to compare HWPP to MWPP mesh in CDC class II-III wounds during open RMVHR.
METHODS: The Abdominal Core Health Quality Collaborative database was retrospectively queried for a cohort of patients who underwent open RMVHR with MWPP or HWPP mesh placed in CDC class II/III wounds from 2012 to 2023. Mesh types were compared using a 3:1 propensity score-matched analysis. Covariates for matching included CDC classification, BMI, diabetes, smoking within 1 year, hernia, and mesh width. Primary outcome of interest included wound complications. Secondary outcomes included reoperations and readmissions at 30 days.
RESULTS: A total of 1496 patients received MWPP or HWPP (1378 vs. 118, respectively) in contaminated RMVHR. After propensity score matching, 351 patients remained in the mediumweight and 117 in the heavyweight mesh group. There were no significant differences in surgical site infection (SSI) rates (13.4% vs. 14.5%, p = 0.877), including deep SSIs (0.3% vs. 0%, p = 1), surgical site occurrence rates (17.9% vs. 22.2%, p = 0.377), surgical site occurrence requiring procedural intervention (16% vs. 17.9%, p = 0.719), mesh removal (0.3% vs. 0%, p = 1), reoperations (4.6% vs. 2.6%, p = 0.428), or readmissions (12.3% vs. 9.4%, p = 0.504) at 30 days.
CONCLUSIONS: HWPP mesh was not associated with increased wound morbidity, mesh excisions, reoperations, or readmissions in the early postoperative period compared with MWPP mesh in open RMVHR for CDC II/III cases. Longer follow-up will be necessary to determine if HWPP mesh may be a suitable alternative to MWPP mesh in contaminated scenarios.