title: Evaluation of high-risk, comorbid patients undergoing open ventral hernia repair with synthetic mesh.
abstract: BACKGROUND
  The Ventral Hernia Working Group proposed recently a classification system to grade the risk of surgical site occurrence (SSO) during ventral hernia repair (VHR). Accurately predicting the outcomes of synthetic mesh in open VHR for comorbid patients might guide surgeons in appropriate mesh selection in this patient population. Our objective was to determine the incidence of SSO in open, grade II VHR and to examine the use of synthetic mesh in these comorbid patients.
  
  
  METHODS
  All open, grade II VHR performed by a single surgeon over a 4-year period were reviewed retrospectively.
  
  
  RESULTS
  Eighty-eight patients (43 female; mean age, 57 years) with grade II ventral hernias underwent open VHR with synthetic mesh. Associated comorbidities included obesity in 55 (63%), diabetes mellitus in 43 (49%), chronic obstructive pulmonary disease in 27 (31%), smoking in 21 (24%), and immunosuppression in 18 (21%). The mean number of comorbidities per patient was 1.9 (range, 1-4). SSO occurred in 14 (16%) patients and included infection (n = 11), seroma (n = 2), and wound dehiscence (n = 1). Having multiple comorbidities was associated with an increased risk of SSO (P = .02). Three (3%) patients required reoperation or readmission for wound management. With a mean follow-up of 17.8 months, 4 (5%) patients developed a hernia recurrence.
  
  
  CONCLUSIONS
  Patients with grade II hernias undergoing open VHR are prone to SSO with an incidence of 16%. Although synthetic mesh infections can occur among grade II patients, the majority can be managed conservatively with salvage of the prosthesis, especially if macroporous mesh is used. Given our findings, the use of synthetic mesh in the retrorectus space results in a safe and durable (5% recurrence rate) repair for patients with grade II incisional hernias.
authors.affiliation: Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH 44106, USA. david.krpata@uhhospitals.org.
authors.forename: David M
authors.initials: DM
authors.lastname: Krpata
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Blatnik
authors.forename: Yuri W
authors.initials: YW
authors.lastname: Novitsky
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000453:epidemiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh / Q000009:adverse effects; D016896:Treatment Outcome