Do Anticoagulants Have an Impact on the Clinical Outcomes of Ventral Hernia Repair? A Systematic Review and Meta-Analysis.

Abstract

<h4>Aim</h4>This study aims to perform a comprehensive systematic review and meta-analysis to evaluate the impact of anticoagulation (AC) therapy on clinical outcomes during ventral hernia repair (VHR).<h4>Materials and methods</h4>A thorough online search was conducted using PubMed, Cochrane, and Embase databases. Studies comparing the use of AC therapy following VHR were included. The results analyzed were bleeding-related reoperation, hemorrhagic/thrombotic complications, length of stay, and transfusion rates. Statistical analysis was performed with Review Manager 5.4 using a random-effects model.<h4>Results</h4>From 1278 records, 4 studies were included, encompassing 41,868 patients (anticoagulants use = 4804; no AC = 32,649), with 25% on anticoagulant therapy submitted to minimally invasive surgery (MIS). Additionally, 90% of patients using anticoagulants underwent mesh placement. Overall analysis showed increased hemorrhagic/thrombotic complications (risk ratios [RR]: 2.3; 95% confidence interval [CI]: 1.13-4.8; <i>P</i> = .02), bleeding-related reoperation (RR: 6.5; 95% CI: 4.3-9.9; <i>P</i> < .00001), and longer hospital stays (mean difference: 1.69 days; 95% CI: .66 to 2.72 days; <i>P</i> = .001) in patients using anticoagulant medications. However, there was no increased risk of transfusion (RR: 2.14; 95% CI: 0.58-7.95; <i>P</i> = .26) between groups.<h4>Conclusions</h4>The use of anticoagulant therapy following VHR is associated with increased hemorrhagic/thrombotic complications, bleeding-related reoperations, prolonged hospitalization, and similar transfusion rates. Further research is still required to validate these findings and explore the impact of MIS on anticoagulated patients following VHR.