The Costs and Complications Associated with Infected Ventral Hernia Repair Mesh

Author(s):
Margaret Plymale; Daniel Davenport; Jordan Hess; Willliam Griffiths; Seth Walsh Blackmore; Mary Plymale; Crystal Totten; John Roth

Background:

Mesh hernia repair is widely accepted due to the associated reduction in hernia recurrence compared to suture-based repair. Despite initiatives to reduce risk, mesh infection and mesh removal are a significant challenge. In an era of healthcare value, it is essential to understand the global cost of care including the incidence and cost of complications. The purpose of this study was to identify the outcomes and costs of care of patients that required removal of infected hernia mesh.

Hypothesis:

Costs and complications associated with infected mesh are significantly greater than those associated with non-complicated ventral hernia repair.

Methods:

A review of databases from 2006 through June 2018 identified patients that underwent both ventral hernia repair (VHR) and reoperation for infected mesh removal. Patient demographic and operative details for both procedures including age, body mass index, mesh type, amount of time between procedures, and information regarding interval procedures was obtained. Clinical outcome measures included length of hospital stay, hospital readmission, wound and non-wound complications, and reoperation. Hospital cost data was obtained from the cost accounting system and was combined with the clinical data for a cost and clinical representation of the cases.

Results:

37 patients had VHR and removal of infected mesh material over the 12 year time frame: average age at VHR was 49 years (+/- 14) and 17 patients (46%) were female. Following VHR, 13 patients (35%) experienced wound complications within 90 days postop which ranged from superficial surgical site infection to evisceration. A median of 217 days (IQR 36-1,104) passed between procedures. After mesh removal 17 patients (46%) experienced further wound complications, and 24 (65%) patients had at least 1 readmission. 21 patients (57%) required a minimum of one additional operative procedure after mesh removal. Median hospital costs nearly doubled (p < .001) for the mesh removal (25,495, IQR 13,635 – 45,081) compared to the VHR admission (13,802, IQR 8,776 – 27,175) not accounting for readmission costs. A majority experienced hernia recurrence subsequent to mesh removal.

Conclusions:

Mesh infection following hernia repair is associated with significant morbidity and costs. Hospital readmission, reoperations and recurrences are common among these patients resulting in increased healthcare resource utilization. Development strategies to prevent mesh infection, identify patients most likely to experience infectious complications, and define best practices for care of patients with mesh infection are needed.