In:
ANZ Journal of Surgery, Wiley, Vol. 90, No. 11 ( 2020-11), p. 2248-2253
Abstract:
The safety of synthetic mesh in elective hernia repair in the setting of immunosuppression lacks national and international consensus. The aim of our analysis was to explore the effects of immunosuppression on the rates of wound complications. Methods Comparative analysis of immunocompetent and immunocompromised patients with elective mesh repair of inguinal, femoral, primary ventral, incisional or parastomal hernia between January 2001 and December 2013. Immunosuppression included glucocorticoids, biologicals, chemotherapy and chemoradiotherapy. Primary outcome parameter was mesh infection rate. Follow‐up questionnaires were completed in written form or by telephone interview. Results Questionnaire response rate was 59.5% ( n = 194) with a median follow‐up of 33 (interquartile range: 28–41) months. There were no differences between immunocompromised ( n = 40, 20.6%) and immunocompetent patients ( n = 154, 79.4%) based on hernia and patient characteristics. Immunosuppression was not associated with the rates of mesh infection ( P = 1.000), surgical site infection (SSI, P = 0.330) or re‐operation for SSI ( P = 0.365), but with higher rates ( P = 0.007) and larger odds for hernia recurrence (odds ratio 3.264, 95% confidence interval 1.304–8.172; P = 0.012). Mesh infection also increased the odds for hernia recurrence (odds ratio 11.625; 95% confidence interval 1.754–77.057; P = 0.011). Only in the subset of ventral/incisional hernias, immunocompromised ( n = 8, 40%) patients had higher recurrence rates than immunocompetent patients ( n = 5, 11.6%; P = 0.017). Patients with SSI reported more frequently moderate to severe dysesthesia at the surgical site ( P = 0.013) and would less frequently re‐consent to surgery ( P = 0.006). Conclusion Immunosuppression does not increase the rate of wound infections after elective hernia repair with synthetic mesh. However, immunosuppression and mesh infection are risk factors for hernia recurrence.
Type of Medium:
Online Resource
ISSN:
1445-1433
,
1445-2197
Language:
English
Publisher:
Wiley
Publication Date:
2020
detail.hit.zdb_id:
2095927-8
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