Long-Term Risk of Mesh Infection Requiring Removal After Elective Ventral Hernia Repair.

Abstract

<h4>Importance</h4>Hundreds of thousands of people have mesh placed for ventral hernia repair every year, but the long-term risks of clinically significant mesh infection requiring mesh removal remain unknown.<h4>Objective</h4>To examine the risk of clinically significant mesh infection requiring removal after ventral hernia repair.<h4>Design, setting, and participants</h4>This retrospective cohort study included 100% Medicare fee-for-service administrative claims data from January 1, 2011, to December 31, 2021, for adults aged 18 years or older who underwent elective inpatient open ventral hernia repair with mesh. Data were analyzed from October 21, 2024, to May 2, 2025.<h4>Exposure</h4>Mesh placed at the time of ventral hernia repair.<h4>Main outcomes and measures</h4>The primary outcome was mesh removal up to 10 years after the index operation. Current Procedural Terminology codes were used to identify mesh removal, which was used as a surrogate measure for a clinically significant mesh infection. Secondary outcomes included the association between 30-day wound complications and subsequent mesh removal.<h4>Results</h4>Of 59 453 people (35 209 female [59.2%]), 1330 (2.2%) underwent mesh removal with a median time to mesh removal of 8 months (238 days; 25th to 75th percentile = 49 to 757 days = 2 to 25 months). People who underwent mesh removal were more often female than people who did not undergo mesh removal (63.0% [838] vs 59.1% [34 371]; P = .005), more often underwent enterectomy (3.5% [46] vs 2.3% [1342]; P = .008), and more often experienced a wound complication within 30 days (23.6% [314] vs 6.6% [3825]; P < .001). The cumulative hazard percentage of mesh removal for a patient with wound complications at 10-year follow-up was 7.94 (95% CI, 7.03-8.84) compared with 2.48 (95% CI, 2.31-2.64) for patients without. Most mesh removals occurred within the first 5 years after surgery.<h4>Conclusions and relevance</h4>These findings suggest that the risk of mesh removal is low overall, even for people who experience a wound complication. These findings support the broad use of mesh for people undergoing elective open ventral hernia repair.