title: Assessing complications and cost-utilization in ventral hernia repair utilizing biologic mesh in a bridged underlay technique.
abstract: BACKGROUND
  The inability to reapproximate fascia in complex ventral hernia (CVH) repair remains challenging. Single-stage bridging reconstructions have been reported, however, with high rates of recurrence and wound complications. We describe a single-surgeon experience with bridging biologic CVH repair.
  
  
  METHODS
  We reviewed 37 patients undergoing CVH repair with bridging biologic mesh by the senior author from January 1, 2007 to January 1, 2013. Surgical history and operative characteristics were analyzed for predictors of hernia recurrence and wound complications.
  
  
  RESULTS
  Average age was 53 ± 15 years, body mass index was 31.1 ± 8.1 kg/m(2), and history of prior repair in 18 patients. Common indications were trauma, intra-abdominal infection, and prior intra-abdominal surgery. Incidence of wound complications was 51.4%, most commonly wound breakdown and infection. With average follow-up of 13 months, recurrence rate was 18.9% at an average of 8.2 months postoperatively. Analysis demonstrated postoperative wound infection as the only predictor of recurrence (odds ratio = 22.1, P = .017).
  
  
  CONCLUSIONS
  Hernia recurrence rate was 18.9% with bridged biologic CVH repairs, strongly associated with postoperative wound infection. This suggests that patients with postoperative infections may benefit from closer surveillance and more aggressive wound management.
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, Pennsylvania, PA 19104, USA.
authors.forename: Marten N
authors.initials: MN
authors.lastname: Basta
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, Pennsylvania, PA 19104, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, Pennsylvania, PA 19104, USA. Electronic address: stephen.kovach@uphs.upenn.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
mesh_terms: D001688:Biological Products; D001705:Bioprosthesis / Q000191:economics*; D005260:Female; D006555:Hernia, Ventral / Q000191:economics* / Q000601:surgery*; D059685:Herniorrhaphy / Q000191:economics* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000191:economics*; D013530:Surgical Wound Infection / Q000453:epidemiology*
chemical_list: D001688:Biological Products
keywords: Abdominal wall reconstruction; Acellular dermal matrix; Biologic mesh; Complex ventral hernia repair; Cost utilization; Surgical complications