Ramos et al identified risk factors for mesh explantation because of infection following hernia repair. These can help to identify a patient who may require more aggressive management. The authors are from Veterans Affairs Boston, Boston University and Harvard Medical School.
Types of hernias:
(1) inguinal
(2) umbilical
(3) ventral
Most infections requiring mesh removal occur within the first 90 days, but the risk may persist for 5 years or more.
Risk factors for mesh explantation due to infection:
(1) increased body weight (overweight, obese or morbidly obese)
(2) ASA status 3 to 5 (OR 1.7)
(3) longer duration of the surgical procedure (OR 1.8)
(4) contaminated or dirty wound classification (CDC Class 3 or 4; OR 2.3)
(5) umbilical hernia repair (OR 6.1)
(6) ventral hernia repair (OR 14.4)
(7) open repair (OR 3.6)
(8) surgical site infection (deep incisional > organ space > superficial)
(9) subsequent abdominal operation
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