Long-term safety and recurrence after emergency ventral hernia mesh

Abstract

<h4>Importance</h4>Wide variation exists in how surgeons approach the repair of emergent presentation of ventral hernias, with many opting to avoid mesh in the acute setting. The long-term recurrence rates after emergent hernia repair and the effects of mesh on safety and recurrence remain poorly characterized.<h4>Objective</h4>To evaluate the long-term reoperation rate for recurrence and safety of mesh use after emergent ventral hernia repair.<h4>Design, setting, and participants</h4>This retrospective cross-sectional study of adults aged 18 years or older who underwent emergent inpatient ventral hernia repair used 100% Medicare administrative claims data from January 1, 2011, to December 31, 2021. Patients were followed up through death or termination of Medicare insurance. The data analysis was conducted between April and December 2024.<h4>Exposures</h4>Open hernia repair with or without mesh use and with or without enterectomy.<h4>Main outcomes and measures</h4>The primary outcome was the reoperation rate for recurrence after open emergent hernia repair stratified by mesh use. The secondary outcome was mesh explantation rates for emergent open repairs performed with and without enterectomy. The time-to-event analysis used Royston-Parmar models.<h4>Results</h4>A total of 122 651 adult Medicare beneficiaries (mean [SD] age, 71.4 [21.0] years; 71 463 females [58.3%]) underwent emergent ventral hernia repair from 2011 to 2021. The median time to the follow-up event after the index hernia surgery was 3.2 years (IQR, 1.1-6.0 years). The 10-year reoperation rate for recurrence after emergency ventral hernia repair was 16.3% (95% CI, 15.9%-16.6%). Among emergent open repairs, 30 922 (30.0%) were repaired with mesh. Of those undergoing emergent open repairs with enterectomy, 2055 patients (18.2%) received mesh. Overall, patients repaired with mesh had significantly lower 10-year recurrence rates than those repaired without mesh (13.0% [95% CI, 13.0%-13.8%] vs 18.9% [18.4%-18.9%]; hazard ratio [HR], 0.66 [95% CI, 0.63-0.69]; P < .001). Mesh explantation rates up to 10 years after surgery were not significantly different between emergent open repairs that did and did not require enterectomy (3.8% [95% CI, 2.8%-4.8%] vs 3.2% [95% CI, 2.9%-3.4%]; HR, 1.20 [95% CI, 0.91-1.59]).<h4>Conclusions and relevance</h4>In this cross-sectional study of patients undergoing emergent open hernia repairs, mesh use was associated with decreased risk of recurrence and was not associated with increased risk of mesh explantation in the setting of enterectomy. This study suggests that surgeons may consider more consistent use of mesh in the emergent setting to possibly improve long-term outcomes.