Mesh choice in ventral hernia repair: so many choices, so little time
Mesh choice in ventral hernia repair: so many choices, so little time
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DOI：
10.1016/j.amjsurg.2013.01.026
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发表时间：
2013-05-01
影响因子：
3
通讯作者：
Martindale, Robert G.
中科院分区：
文献类型：
--
作者：
Le, Dinh;Deveney, Clifford W.;Martindale, Robert G.
背景：目前，>；200网状物在美国市场上可以买到。为了帮助指导合适的网片选择，研究人员检查了2008-2011年间所有在其机构接受腹股沟修补术的患者的术后经历，并进行了12个月的随访。方法：对前瞻性收集的数据进行回顾。检查所有并发症或复发的返回情况(手术再入院、办公室或紧急就诊)。评估了人口学因素(年龄、性别和体重指数[BMI])、危险因素(疝气分级、疝气大小、同时和既往减肥手术、同时和既往器官移植、任何同时手术和美国麻醉学家协会评分)以及假体类型(聚丙烯、其他合成的人类脱细胞真皮基质、非交联猪来源的脱细胞真皮基质、其他生物或无)对复发频率的影响。结果：共有564名患者获得了12个月的随访，417名患者获得了18个月的随访。在单变量回归分析中，研究ARM(生物修复、人工修复或初次修复)、疝气分级、疝气大小、既往减肥手术和美国麻醉师学会评分是复发的显著预测因素(P<；0.05)。多变量分析、逐步回归和交互作用测试确定了三个具有显著预测力的变量：腹股沟分级、腹股沟大小和BMI。12个月时，3级和4级再入院的调整优势比分别为2.6(95%可信区间，1.3~5.1)和2.6(95%可信区间，1.1~6.4)，2.3(95%可信区间，1.1~4.6)，4.2(95%可信区间，1.7~10.0)。大的腹股沟(调整后的优势比与小的优势比为3.2；95%的可信区间为1.6至6.2)和较高的BMI(调整后的BMI和GT；=50 vs 30至34.99 kg/m(2)，5.7；95%的可信区间为1.2至26.2)增加了12个月内再次手术入院的可能性。结论：目前的数据支持这样的假设，即仔细匹配患者的特征和选择假体将最大限度地减少并发症、再次住院和术后办公室就诊的次数。(C)2013 Elsevier Inc.保留所有权利。
BACKGROUND: Currently, >200 meshes are commercially available in the United States. To help guide appropriate mesh selection, the investigators examined the postsurgical experiences of all patients undergoing ventral hernia repair at their facility from 2008 to 2011 with >= 12 months of follow-up.METHODS: A retrospective review of prospectively collected data was conducted. All returns (surgical readmission, office or emergency visit) for complications or recurrences were examined. The impact of demographics (age, gender, and body mass index [BMI]), risk factors (hernia grade, hernia size, concurrent and past bariatric surgery, concurrent and past organ transplantation, any concurrent surgery, and American Society of Anesthesiologists score), and prosthetic type (polypropylene, other synthetic, human acellular dermal matrix, non-cross-linked porcine-derived acellular dermal matrix, other biologic, or none) on the frequency of return was evaluated.RESULTS: A total of 564 patients had 12 months of follow-up, and 417 patients had 18 months of follow-up. In a univariate regression analysis, study arm (biologic, synthetic, or primary repair), hernia grade, hernia size, past bariatric surgery, and American Society of Anesthesiologists score were significant predictors of recurrence (P < .05). Multivariate analysis, stepwise regression, and interaction tests identified three variables with significant predictive power: hernia grade, hernia size, and BMI. The adjusted odds ratios vs hernia grade 2 for surgical readmission were 2.6 (95% confidence interval [CI], 1.3 to 5.1) for grade 3 and 2.6 (95% CI, 1.1 to 6.4) for grade 4 at 12 months and 2.3 (95% CI, 1.1 to 4.6) for grade 3 and 4.2 (95% CI, 1.7 to 10.0) for grade 4 at 18 months. Large hernia size (adjusted odds ratio vs small size, 3.2; 95% CI, 1.6 to 6.2) and higher BMI (adjusted odds ratio for BMI >= 50 vs 30 to 34.99 kg/m(2), 5.7; 95% CI, 1.2 to 26.2) increased the likelihood of surgical readmission within 12 months.CONCLUSIONS: The present data support the hypothesis that careful matching of patient characteristics to choice of prosthetic will minimize complications, readmissions, and the number of postoperative office visits. (C) 2013 Elsevier Inc. All rights reserved.