Hospital-level variability in incisional hernia repair technique affects patient outcomes.
BACKGROUND
Mesh placement during ventral incisional hernia repair has been shown to result in superior outcomes; however, significant variation persists in the adoption of this technique. We performed a multi-institutional study to understand how variation in surgical technique influences outcomes.


METHODS
This study is a retrospective, facility-level analysis of incisional hernia repairs performed at 16 veteran's administration medical centers between 1997 and 2002. Operative notes and a postoperative course were physician-abstracted from the medical record. Hospital rates for the type of hernia repair, mesh placement, and recurrence were calculated. Spearman's correlation and generalized linear models were performed.


RESULTS
A total of 1,612 incisional hernia repairs with a median follow-up of 66.2 months were included in the study. The mean rate of mesh implantation was 63.7% but ranged from 37.5% to 90%. The 5-year recurrence rate was 25.6% and ranged from 16.0% to 38.4%. The rate of mesh use for the incisional hernia repair at the hospital level was associated significantly with the hospital recurrence rate for all cases (R(2) = .27; P = .04) and elective cases (R(2) = .31; P = .02). For every 10% increase in the rate of mesh placement, a corresponding 3.1% decrease was noted in the recurrence rates (P = .001). The hospital rate of mesh use was not associated significantly with rates of complications or patient satisfaction.


CONCLUSIONS
Hospitals that adopted a higher rate of mesh repair for incisional hernia repairs had lower recurrence rates. These data support that the efficacy of mesh repair previously proven in clinical trials is highly translatable to effective practice in the field. Continued studies on the attributable risk of complications to mesh placement are ongoing.
The Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham Veterans Administration Hospital, Birmingham, AL, USA. mhawn@uab.edu
Mary T
MT
Hawn
Christopher W
CW
Snyder
Laura A
LA
Graham
Stephen H
SH
Gray
Kelly R
KR
Finan
Catherine C
CC
Vick
D000328:Adult; D000368:Aged; D006555:Hernia, Ventral / Q000601:surgery*; D006787:Hospitals, Veterans; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D016896:Treatment Outcome