Variation in mesh placement for ventral hernia repair: an opportunity for process improvement?
BACKGROUND
Incisional hernia repair (IHR) with mesh has been associated with decreased hernia recurrence. We analyzed variation in mesh use for IHR.


METHODS
A cohort undergoing IHR from 16 Veterans' Administration (VA) Hospitals was identified. Patient-specific variables were obtained from National Surgical Quality Improvement Program (NSQIP) data. Operative variables were obtained from physician-abstracted operative notes. Univariate and multivariable logistic regression analyses were used to model mesh implantation predictors.


RESULTS
A total of 1,123 IHR cases were analyzed; Mesh was implanted in 69.6% (n = 781). Regression models demonstrated repair at a high performing facility was associated with a nearly 4-fold increase in mesh utilization. Other significant predictors include repair of recurrent hernia, chronic steroid use, and multiple fascial defects.


CONCLUSIONS
There is variation in the rate of mesh placement for IHR by VA facility, even after accounting for key explanatory variables. Patterns of mesh placement in IHR appear to be based on practice style.
Gray
Stephen H
SH
Deep South Center for Effectiveness Research, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL, USA.
Vick
Catherine C
CC
Graham
Laura A
LA
Finan
Kelly R
KR
Neumayer
Leigh A
LA
Hawn
Mary T
MT
D015331:Cohort Studies; D000071938:Fasciotomy; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006555:Hernia, Ventral / Q000601:surgery*; D006787:Hospitals, Veterans; D006801:Humans; D007422:Intestines / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011126:Polypropylenes; D011138:Polytetrafluoroethylene; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D014481:United States
D005938:Glucocorticoids; D011126:Polypropylenes; D011138:Polytetrafluoroethylene