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Purpose <p>To compare long-term recurrence and reoperation outcomes in ventral hernia repairs (VHR) and abdominal wall reconstructions (AWR) using absorbable mesh (AM: synthetic and biologic) versus permanent mesh (PM) across CDC wound class 1–4.</p> Methods <p>Adult patients who underwent first-time elective VHR or AWR with mesh were identified using Kaiser Permanente’s integrated electronic health record (2010–2023). PM repairs were 1:1 propensity score-matched to AM repairs. Cumulative incidence via the Kaplan-Meier estimate and multivariable Cox regression were used to evaluate risk for hernia recurrence and reoperation for recurrence; secondary analysis evaluated outcomes by wound class 1, 2, and 3/4.</p> Results <p>Among 24,822 VHR and 1,341 AWR, AM were used in 1,330 (5.4%) VHR and 290 (21.6%) AWR. After matching, the 10-year cumulative recurrence was 33.7% for VHR with AM versus 25.3% for PM and AM was associated with a higher risk of recurrence (HR = 1.40, 95% CI = 1.19–1.64) and reoperation (HR = 1.81, 95% CI = 1.28–2.56) versus PM. In VHR subset analysis, AM associated with a higher recurrence risk in wound class 1 (HR = 1.53, 95% CI = 1.21–1.94) and wound class 3/4 (HR = 2.20, 95% CI = 1.08–4.94) and reoperation risk in wound class 1 (HR = 1.65, 95% CI = 1.01–2.70) and wound class 2 (HR = 1.76, 95% CI = 1.01–3.06). Synthetic and biologic AM each had higher recurrence versus PM; biologic AM also had higher reoperation. For AWR, no differences were observed at 6 years.</p> Conclusion <p>In this large, long-term propensity-matched cohort, AM for VHR was associated with higher recurrence and reoperation risk than PM, including in contaminated fields.</p>

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Absorbable mesh is associated with a higher risk of recurrence and reoperation: a propensity score-matched comparison of mesh performance in clean and contaminated ventral hernia repairs

  • 期刊论文

  • 发表日期：

    2025年10月31日

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  • Sahil Patel,
  • Priscilla H. Chan,
  • Brandon Cowan,
  • Heather A. Prentice,
  • Kenneth Sucher,
  • Elizabeth W. Paxton,
  • Elliott Brill,
  • Robert Bell,
  • Rouzbeh Mostaedi

摘要

Purpose

To compare long-term recurrence and reoperation outcomes in ventral hernia repairs (VHR) and abdominal wall reconstructions (AWR) using absorbable mesh (AM: synthetic and biologic) versus permanent mesh (PM) across CDC wound class 1–4.

Methods

Adult patients who underwent first-time elective VHR or AWR with mesh were identified using Kaiser Permanente’s integrated electronic health record (2010–2023). PM repairs were 1:1 propensity score-matched to AM repairs. Cumulative incidence via the Kaplan-Meier estimate and multivariable Cox regression were used to evaluate risk for hernia recurrence and reoperation for recurrence; secondary analysis evaluated outcomes by wound class 1, 2, and 3/4.

Results

Among 24,822 VHR and 1,341 AWR, AM were used in 1,330 (5.4%) VHR and 290 (21.6%) AWR. After matching, the 10-year cumulative recurrence was 33.7% for VHR with AM versus 25.3% for PM and AM was associated with a higher risk of recurrence (HR = 1.40, 95% CI = 1.19–1.64) and reoperation (HR = 1.81, 95% CI = 1.28–2.56) versus PM. In VHR subset analysis, AM associated with a higher recurrence risk in wound class 1 (HR = 1.53, 95% CI = 1.21–1.94) and wound class 3/4 (HR = 2.20, 95% CI = 1.08–4.94) and reoperation risk in wound class 1 (HR = 1.65, 95% CI = 1.01–2.70) and wound class 2 (HR = 1.76, 95% CI = 1.01–3.06). Synthetic and biologic AM each had higher recurrence versus PM; biologic AM also had higher reoperation. For AWR, no differences were observed at 6 years.

Conclusion

In this large, long-term propensity-matched cohort, AM for VHR was associated with higher recurrence and reoperation risk than PM, including in contaminated fields.