title: Predictors of mesh explantation after incisional hernia repair.
abstract: BACKGROUND
  Prosthetic mesh used for incisional hernia repair (IHR) reduces hernia recurrence. Mesh infection results in significant morbidity and challenges for subsequent abdominal wall reconstruction. The risk factors that lead to mesh explantation are not well known.
  
  
  METHODS
  This is a multisite cohort study of patients undergoing IHR at 16 Veterans Affairs hospitals from 1998 to 2002.
  
  
  RESULTS
  Of the 1,071 mesh repairs, 55 (5.1%) had subsequent mesh explantation at a median of 7.3 months (interquartile range 1.4-22.2) after IHR with permanent mesh prosthesis. Infection was the most common reason for explantation (69%). No differences were observed by the type of repair. Adjusting for covariates, same-site concomitant surgery (hazard ratio [HR] = 6.3) and postoperative surgical site infection (HR = 6.5) were associated with mesh explantation.
  
  
  CONCLUSIONS
  Patients undergoing IHR with concomitant intra-abdominal procedures have a greater than 6-fold increased hazard of subsequent mesh explantation. Permanent prosthetic mesh should be used with caution in this setting.
authors: Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Administration Hospital, AL 35233, USA. mhawn@uab.edu
authors: Mary T
authors: MT
authors: Hawn
authors: Stephen H
authors: SH
authors: Gray
authors: Christopher W
authors: CW
authors: Snyder
authors: Laura A
authors: LA
authors: Graham
authors: Kelly R
authors: KR
authors: Finan
authors: Catherine C
authors: CC
authors: Vick
mesh_terms: D015331:Cohort Studies; D020878:Device Removal / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011126:Polypropylenes; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000601:surgery; D013526:Surgical Mesh / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000601:surgery; D014481:United States / Q000453:epidemiology
chemical_list: D011126:Polypropylenes