title: Use of mesh during ventral hernia repair in clean-contaminated and contaminated cases: outcomes of 33,832 cases.
abstract: OBJECTIVE
  To analyze and compare postoperative occurrences following ventral hernia repairs (VHRs) using mesh in clean-contaminated and contaminated wounds.
  
  
  BACKGROUND
  Ventral hernia repairs using mesh is one of the most common surgical procedures performed. However, guidelines and outcomes of repairs in clean-contaminated or grossly contaminated ventral hernias have not been established.
  
  
  METHODS
  Patients who underwent VHR with mesh between the dates January 1, 2005 and April 4, 2010 at all hospitals in the United States participating in the National Surgical Quality Improvement Program (NSQIP) were reviewed. Data from 33,832 patients were analyzed by field contamination level and then compared with data from patients who underwent VHR without mesh. Data were analyzed using the odds ratio test with a 95% confidence interval.
  
  
  RESULTS
  The odds of having one or more postoperative occurrences were significantly greater in clean-contaminated and contaminated cases using mesh when compared with clean cases, with odds ratios of 3.56 (3.25-3.89) and 5.05 (1.78-12.41), respectively. There was a significantly increased risk of superficial surgical site infections (SSI) (2.53), deep SSI (3.09) and organ/space SSI (6.16), wound disruption (4.41), pneumonia (4.43), and sepsis (4.90) for clean-contaminated cases. Both clean-contaminated and contaminated cases had an increased risk of septic shock (5.82 and 26.74, respectively), and need for ventilator for more than 48 hours (5.59 and 26.76, respectively). In addition, there was a significantly increased odds ratio of complications in patients who underwent VHR with mesh (3.56) to nonmesh (2.52) in clean-contaminated cases.
  
  
  CONCLUSIONS
  There is a significant increase in risk of postoperative occurrences following VHRs using mesh in clean-contaminated and contaminated cases relative to clean cases. We recommend avoiding the use of mesh in any level of contamination.
authors.affiliation: Division of General Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, USA.
authors.forename: Jacqueline J
authors.initials: JJ
authors.lastname: Choi
authors.forename: Nandini C
authors.initials: NC
authors.lastname: Palaniappa
authors.forename: Kai B
authors.initials: KB
authors.lastname: Dallas
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Rudich
authors.forename: Modesto J
authors.initials: MJ
authors.lastname: Colon
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology / Q000209:etiology; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome