Use of mesh for repair of an incisional hernia varies with the surgeon's style, not the patient's condition
The use of a specifically positioned plastic mesh to repair a protrusion at the site of a previous incision (incisional hernia repair, or IHR) is not typically related to the patient's medical situation or demographics, according to a new study. Despite prior evidence that systematic placement of mesh can reduce the risk of hernia recurrence by half (from 43 percent for suture-only repair to 23 percent for repair with mesh), the study of IHRs done at 16 hospitals run by the Department of Veterans Affairs (VA) did not find consistent use of this procedure by surgeons.
The researchers gathered data on all patients undergoing IHR at the VA hospitals over a 4-year period. Of the 1,123 procedures available for analysis, mesh was used in 781 cases (70 percent). However, the mesh and suture-only cases did not differ in patient characteristics, including the presence of co-existing conditions before surgery. The percentage of mesh use in IHR depended primarily on the VA medical center involved, varying from 40 percent to 91 percent among the centers. IHR at a high performing facility was associated with a nearly four-fold increase in mesh use.
The variation in mesh use for IHR suggests opportunity for improvement in IHR outcomes, especially if additional research identifies specific populations that consistently benefit from mesh use, note the researchers. The study was funded in part by the Agency for Healthcare Research and Quality (HS13852).
More details are in "Variations in mesh placement for ventral hernia repair: An opportunity for process improvement?" by Stephen H. Gray, M.D., Catherine C. Vick, M.S., Laura A. Graham M.P.H., and others in the August 2008 The American Journal of Surgery 196(2), pp. 201-206.
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