Absorbable mesh is associated with a higher risk of recurrence and reoperation: a propensity score-matched comparison of mesh performance in clean and contaminated ventral hernia repairs.

Abstract

<h4>Purpose</h4>To compare long-term recurrence and reoperation outcomes in ventral hernia repairs (VHR) and abdominal wall reconstructions (AWR) using absorbable mesh (AM: synthetic and biologic) versus permanent mesh (PM) across CDC wound class 1-4.<h4>Methods</h4>Adult patients who underwent first-time elective VHR or AWR with mesh were identified using Kaiser Permanente's integrated electronic health record (2010-2023). PM repairs were 1:1 propensity score-matched to AM repairs. Cumulative incidence via the Kaplan-Meier estimate and multivariable Cox regression were used to evaluate risk for hernia recurrence and reoperation for recurrence; secondary analysis evaluated outcomes by wound class 1, 2, and 3/4.<h4>Results</h4>Among 24,822 VHR and 1,341 AWR, AM were used in 1,330 (5.4%) VHR and 290 (21.6%) AWR. After matching, the 10-year cumulative recurrence was 33.7% for VHR with AM versus 25.3% for PM and AM was associated with a higher risk of recurrence (HR = 1.40, 95% CI = 1.19-1.64) and reoperation (HR = 1.81, 95% CI = 1.28-2.56) versus PM. In VHR subset analysis, AM associated with a higher recurrence risk in wound class 1 (HR = 1.53, 95% CI = 1.21-1.94) and wound class 3/4 (HR = 2.20, 95% CI = 1.08-4.94) and reoperation risk in wound class 1 (HR = 1.65, 95% CI = 1.01-2.70) and wound class 2 (HR = 1.76, 95% CI = 1.01-3.06). Synthetic and biologic AM each had higher recurrence versus PM; biologic AM also had higher reoperation. For AWR, no differences were observed at 6 years.<h4>Conclusion</h4>In this large, long-term propensity-matched cohort, AM for VHR was associated with higher recurrence and reoperation risk than PM, including in contaminated fields.