Complex abdominal wall hernia repair with biologic mesh in elderly: a propensity matched analysis

Abstract

Background Complex abdominal wall reconstruction (CAWR) has become a common surgical procedure both in non-elderly and elderly patients. Objective The aim of this study is to analyze the outcomes of the elderly compared to nonelderly undergoing CAWR using propensity score matching. Methods All patients who underwent CAWR using porcine-derived, non-crosslinked acellular dermal matrix (ADM) (Strat-tice™) between January 2014 and July 2017 were studied retrospectively. Propensity matched analysis was performed for risk adjustment in multivariable analysis and for one-to-one matching. The outcomes were analyzed for differences in postoperative complications, reoperations, mortality, hospital length of stay and adverse discharge disposition. Results One hundred-thirty-six patients were identified during the study period. Non-elderly (aged 18-64 years) constituted 70% (n = 95) and elderly (aged ≥ 65 years) comprised 30% of the overall patient population (n = 41). Seventy-three (56.7%) were females. After adjustment through the propensity score, which included 35 pairs, the surgical site infection (p = 1.000), wound necrosis (p = 1.000), the need for mechanical ventilation (p = 0.259), mortality (p = 0.083), reoperation rate (p = 0.141), hospital length of stay (p = 0.206), and discharge disposition (p = 0.795) were similar. Conclusion Elderly patients undergoing CAWR with biological mesh have comparable outcomes with non-elderly patients when using propensity matching score.

Biologic Mesh in Surgery: A Comprehensive Review and Meta‐Analysis of Selected Outcomes in 51 Studies and 6079 Patients

“…Three studies were prospective [63–66], one included a mix of prospectively enrolled and retrospectively studies participants [67] and 47 studies were retrospective cohort studies [68–124] (Table 2). Eight studies included only patients with contaminated fields [63, 69, 72, 79, 81, 106, 112, 115].…”

“…Component separation technique (CST) was part of hernia repair for all included patients in 7 studies [64, 84, 94, 105, 114, 115, 121]. Thirty‐five studies were single center [63, 65–68, 71, 73–75, 78, 80, 81, 84–86, 88, 89, 91–99, 103–115, 118–124] and 16 multicenter [64, 69, 70, 72, 76–79, 82, 87, 90, 100–102, 116, 117]. Thirty‐nine studies were published by US centers [63–68, 68, 70, 72, 75–78, 80–82, 84–88, 88, 91, 94–97, 99–102, …”

“…Thirty‐five studies were single center [63, 65–68, 71, 73–75, 78, 80, 81, 84–86, 88, 89, 91–99, 103–115, 118–124] and 16 multicenter [64, 69, 70, 72, 76–79, 82, 87, 90, 100–102, 116, 117]. Thirty‐nine studies were published by US centers [63–68, 68, 70, 72, 75–78, 80–82, 84–88, 88, 91, 94–97, 99–102, 104–116, 118–121, 121], 5 were from Great Britain [69, 79, 90,…”

“…Thirty‐nine studies were published by US centers [63–68, 68, 70, 72, 75–78, 80–82, 84–88, 88, 91, 94–97, 99–102, 104–116, 118–121, 121], 5 were from Great Britain [69, 79, 90, 103, 122], 3 from France [74, 83, 123], 2 from Italy [89, 117], 3 from the Netherlands [69, 79, 98] and 1 from China [123]. Multivariable regression (MVR) was used in 20 studies [64, 65, 70, 72–74, 78, 82, 83, 85, 86, 88, 90, 91, 93, 97, 99, 100, 102, 102, 107, 113, 119, 123], and propensity score analysis (PSA) was used in 4 studies [91, 102, …”

Predictors of 30‐ and 90‐Day Readmissions After Complex Abdominal Wall Reconstruction With Biological Mesh: A Longitudinal Study of 232 Patients

“…In our previous studies, we have demonstrated that despite great surgical results, patients undergoing CAWR have significant perioperative complications that need to be recognized [14–16]. The aim of our study was to assess predictors of unplanned 30‐day and 90‐day readmissions after CAWR with biological mesh.…”