title: A comparison of outcomes and cost in VHWG grade II hernias between Rives-Stoppa synthetic mesh hernia repair versus underlay biologic mesh repair.
abstract: BACKGROUND
  The current literature is void of evidence-based guidelines regarding optimal choice of mesh. We aim to perform a comparative outcome analysis of synthetic mesh and acellular dermal matrix (ADM) in Ventral Hernia Working Grade (VHWG) grade II hernias with primary fascial closure.
  
  
  METHODS
  A retrospective review of patients undergoing ventral hernia repair (VHR) by the senior author (S.J.K.) from 2007 to 2012 was performed. Patients undergoing VHR with primary fascial closure were risk stratified using the VHWG defined grading system.
  
  
  RESULTS
  Seventy-two patients met the abovementioned inclusion criteria with 45 receiving synthetic mesh and 27 receiving ADM. The mean length of follow-up was 12.1 ± 9.1 months. Patients were, on average, 53.2 ± 11.6 years of age with a BMI of 33.9 ± 10.6 kg/m(2). The overall incidence of surgical site occurrence (SSO) in the cohort was 41.7 % and the incidence of hernia recurrence was 5.6 %. 30-day mortality was 1.2 %. Bivariate analysis demonstrated that obesity (P = 0.038) and number of comorbidities (P = 0.043) were associated with SSO. Bivariate analysis demonstrated that prior failed hernia, use of ADM, and operative time were associated with higher rates of hernia recurrence; however, adjusted multivariate regression found only prior failed hernia (OR = 4.1, P = 0.03) and biologic mesh (OR = 3.4, P = 0.046) to be independently associated with recurrent hernia. Comparison of mesh types revealed few differences in preoperative or operative characteristics between synthetic mesh and acellular dermal matrices (ADM). The rate of hernia recurrence was significantly higher with ADM (14.8 % vs. 0.0 %, P = 0.017). Patients receiving ADM repairs incurred significantly greater cost ($56,142.1 ± 54,775.5 vs. $30,599.8 ± 39,000.8, P < 0.001).
  
  
  CONCLUSIONS
  These data suggest synthetic mesh is indicated in higher risk VHWG grade II repairs. In comparison to ADM, synthetic mesh was associated with significantly fewer hernia recurrences and lower cost utilization at 1-year.
  
  
  METHODS
  Prognostic/risk category, level III.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Hospital of the University of Pennsylvania at the Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA, John.Fischer2@uphs.upenn.edu.
authors.forename: J P
authors.initials: JP
authors.lastname: Fischer
authors.forename: M N
authors.initials: MN
authors.lastname: Basta
authors.forename: M N
authors.initials: MN
authors.lastname: Mirzabeigi
authors.forename: S J
authors.initials: SJ
authors.lastname: Kovach
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D062088:Acellular Dermis / Q000009:adverse effects / Q000191:economics; D000328:Adult; D001672:Biocompatible Materials / Q000009:adverse effects / Q000191:economics; D003365:Costs and Cost Analysis; D005260:Female; D006555:Hernia, Ventral / Q000191:economics / Q000503:physiopathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011379:Prognosis; D019736:Prostheses and Implants / Q000009:adverse effects / Q000191:economics; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects / Q000145:classification / Q000191:economics
chemical_list: D001672:Biocompatible Materials