Value Improvement and Resource Utilization in Complex Abdominal Wall Reconstruction

Although recommendations help guide surgeons’ mesh choice in abdominal wall reconstruction (AWR), financial and institutional pressures may play a bigger role. Standardization of an AWR algorithm may help reduce costs and change mesh preferences. We performed a retrospective review of high- and low-risk patients who underwent inpatient AWR between 2014 and 2016. High risk was defined as immunosuppression and/or history of infection/contamination. Patients were stratified by the type of mesh as biologic/biosynthetic or synthetic. These cohorts were analyzed for outcome, complications, and cost. One hundred twelve patients underwent complex AWR. The recurrence rate at two years was not statistically different between high- and low-risk cohorts. No significant difference was found in the recurrence rate between biologic and synthetic meshes when comparing both high- and low-risk cohorts. The average cost of biologic mesh was $9,414.80 versus $524.60 for synthetic. The estimated cost saved when using synthetic mesh for low-risk patients was $295,391.20. In conclusion, recurrence rates for complex AWR seem to be unrelated to mesh selection. There seems to be an excess use of biologic mesh in low-risk patients, adding significant cost. Implementing a critical process to evaluate indications for biologic mesh use could decrease costs without impacting the quality of care, thus improving the overall value of AWR.

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P014 COMPARATIVE EFFECTIVENESS OF RESORBABLE SYNTHETIC ONLAY AND BIOLOGIC INTRAPERITONEAL MESH FOR ABDOMINAL WALL RECONSTRUCTION: A 2-YEAR MATCHED PAIR ANALYSIS

British Journal of Surgery ◽

10.1093/bjs/znab395.013 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Sammy Othman ◽

Adrienne Christopher ◽

Viren Patel ◽

Hanna Jia ◽

Joseph Mellia ◽

...

Keyword(s):

Abdominal Wall ◽

Relative Effectiveness ◽

Abdominal Wall Reconstruction ◽

Synthetic Mesh ◽

Biologic Mesh ◽

Matched Pair ◽

Recurrence Rates ◽

Matched Pair Analysis ◽

Operative Outcomes ◽

Clean Contaminated

Abstract Aim The literature currently lacks comparative studies examining the relative effectiveness of anatomic planes and mesh selection when combating abdominal wall reconstruction (AWR), particularly when the retrorectus sublay space is not available. The aim of this study was to examine the efficacy of resorbable synthetic mesh onlay (RSOM) plane against biologic mesh in the intraperionteal plane (BIPM). Methods A single center, two surgeon, 5-year retrospective review (2014-2019) was performed examining subjects who underwent AWR in the onlay plane with resorbable synthetic mesh or the intraperitoneal plane with biologic mesh. A matched paired analysis was conducted. Data examining demographic characteristics, intraoperative variables, post-operative outcomes, and costs were analyzed. Results A total of 88 subjects (44 per group) were identified (median follow-up: 24.5 months). The mean age was 57.7 years, with a mean BMI of 30.4 kg/m2. The average defect size was 292 ± 237 cm2, with most wounds being clean-contaminated (48.9%), and 55% having prior failed repair. RSOM subjects were significantly less likely (4.5%) to experience recurrence compared to BIPM (22.7%; p<0.026.). Additionally, RSOM suffered less post-operative surgical site occurrences (18.2% vs. 40.9%;p<0.019) and required fewer procedural interventions (11.4% vs. 36.4%;p<0.011). RSOM was also associated with significantly less total costs ($16,658 ± 14,930) compared to BIPM ($27,645 ± 16,864;p<0.001). Conclusion When faced with hernia repair, the selection of resorbable synthetic mesh in the onlay plane may be preferable to biologic mesh place in the intraperitoneal plane due to lower long-term recurrence rates, surgical site complications, and costs.

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Biologic mesh is non-inferior to synthetic mesh in CDC class 1 & 2 open abdominal wall reconstruction

The American Journal of Surgery ◽

10.1016/j.amjsurg.2021.05.019 ◽

2021 ◽

Author(s):

Jenny M. Shao ◽

Sullivan A. Ayuso ◽

Eva B. Deerenberg ◽

Sharbel A. Elhage ◽

Tanu Prasad ◽

...

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Synthetic Mesh ◽

Biologic Mesh ◽

Class 1

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SP7.2.1 Simultaneous intestinal surgery does not increase complication or recurrence rates after complex abdominal wall reconstruction

British Journal of Surgery ◽

10.1093/bjs/znab361.150 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Alison Wallace ◽

Jeffrey Garner

Keyword(s):

Abdominal Wall ◽

Operating Time ◽

Abdominal Wall Reconstruction ◽

Recurrent Hernia ◽

Ileoanal Pouch ◽

Intestinal Surgery ◽

Recurrence Rates ◽

Operative Outcomes ◽

Significant Difference ◽

Chi Squared

Abstract Aims To compare post-operative outcomes in patients undergoing elective complex abdominal wall reconstruction (CAWR) alone vs. CAWR plus simultaneous intestinal surgery. Methods All patients undergoing elective CAWR over a 10-year period in our unit were identified from a prospectively maintained database and divided into those who had concomitant intestinal surgery (resection, ileoanal-pouch formation, stoma reversal, etc) and those who did not. Simple adhesiolysis, cholecystectomy and gynaecological procedures were not classed as ‘intestinal surgery’. Differences between groups were determined using the paired-t test and the (n-1) Chi-squared test. Results 59 patients underwent elective CAWR, 16 with intestinal surgery and 43 without. The two groups had similar baseline demographics with no significant differences in age, BMI, sex or hernia size. The commonest post-operative complications were pneumonia (33.9%) and wound infections (25.4%) but there were no significant differences in any complication between groups. There was zero 30 and 90 day mortality in either group. The mean operating time in the intestinal group (IG) was significantly longer compared to the CAWR-only group (5.4 +/- 1.3hrs vs 4.1 +/- 1.8hrs, p = <0.05). There was no statistically significant difference between groups in rates of surgical site occurrence (37.5% IG vs 55.81% CAWR-only), mesh infections (0% IG vs 6.98% CAWR-only) or recurrent hernia (6.24% IG vs 9.30% CAWR-only) over a median follow up of 3.0 (0.1-7.8) years. Conclusion Performing simultaneous intestinal surgery during complex abdominal wall repair is safe and does not increase the risk of recurrence or mesh infections in a specialist abdominal reconstruction unit.

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Multipoint Suture Fixation Technique for Abdominal Wall Reconstruction with Component Separation and Onlay Biological Mesh Placement

The American Surgeon ◽

10.1177/000313481708300529 ◽

2017 ◽

Vol 83 (5) ◽

pp. 515-521 ◽

Cited By ~ 3

Author(s):

Brad Denney ◽

Jorge I. De Latorre

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Component Separation ◽

Biologic Mesh ◽

Primary Data ◽

Suture Fixation ◽

Fixation Technique ◽

Recurrence Rates ◽

Mesh Placement

Component separation with mesh reinforcement has become the primary modality for complex abdominal wall reconstruction. However, many fundamental questions remain unanswered, such as whether underlay versus overlay mesh placement is superior, and what is the best means of suture fixation technique for mesh placement? This study presents the senior author's technique for onlay biologic mesh placement with multipoint suture fixation in combination with component separation and its subsequent low recurrence rates. This is a retrospective review of the senior author's cases of component separation with onlay biologic mesh placement during his tenure at the home institution of the University of Alabama at Birmingham. A total of 75 patients were included, all of whom underwent complex abdominal wall reconstruction from September 2002 to April 2012. Patients were excluded from the dataset if their surgery occurred less than two years before date of data collection to give a minimum 2-year follow-up. Patients were identified by Current Procedural Terminology codes for component separation and their charts reviewed by the home institution's electronic medical record. Data point entries included patient demographics and comorbidities, concomitant procedures such as bowel resection or panniculectomy, and characteristics of the reconstruction such as type of mesh used. Primary data endpoints were complications following surgery, particularly recurrence and laxity. A total of 75 patients were included in the study from September 2002 to April 2012 with a minimum 2-year follow-up period. The recurrence rate was 13 per cent and the rate of laxity 2.7 per cent. There was one death (1.35%). The most frequent complication was seromas at a rate of 17 per cent. Multipoint fixation suture technique for abdominal wall reconstruction with component separation and onlay biologic mesh is a reproducible technique with reliably low recurrence rates.

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Commentary on ‘Perioperative complications of complex abdominal wall reconstruction with biologic mesh: A pooled retrospective cohort analysis of cohort of 220 patients from two academic centers’

International Journal of Surgery ◽

10.1016/j.ijsu.2020.01.123 ◽

2020 ◽

Vol 75 ◽

pp. 53-54

Author(s):

Meer M. Chisthi

Keyword(s):

Abdominal Wall ◽

Retrospective Cohort ◽

Perioperative Complications ◽

Cohort Analysis ◽

Abdominal Wall Reconstruction ◽

Biologic Mesh ◽

Retrospective Cohort Analysis

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Is there a protective effect with remote ischemic preconditioning on contrast-induced acute renal injury after coronary angiography in low-risk patients?

Journal of Nephropathology ◽

10.15171/jnp.2019.38 ◽

2018 ◽

Vol 8 (4) ◽

pp. 38-38

Author(s):

Sanaz Soleymani ◽

Hamid Reza Samimagham ◽

Mohammad Tamaddondar ◽

Hossein Farshidi ◽

Mahmood Khayatian ◽

...

Keyword(s):

Coronary Angiography ◽

Serum Creatinine ◽

Protective Effect ◽

Ischemic Preconditioning ◽

Low Risk ◽

Remote Ischemic Preconditioning ◽

Control Group ◽

Renal Biomarkers ◽

Significant Difference ◽

Risk Patients

Introduction: Contrast-induced acute kidney injury (CIN-AKI) is a serious complication of coronary angiography. Given the weaknesses in the common protective methods used to prevent CIN-AKI, a safe and effective strategy is needed. RIPC has been shown to have a nephroprotective effect. Objectives: We aimed to determine the protective effect of RIPC on CIN-AKI after angiography or percutaneous coronary intervention (PCI) in low-risk patients. Patients and Methods: In our study, 140 low-risk patients who needed angiography or PCI, were assigned to either RIPC or control group. In each group, serum creatinine and urinary neutrophil gelatinaseassociated lipocalin (uNGAL) were measured before the procedure. Serum creatinine was measured daily for 2 days and uNGAL was measured 6 and 24 hours after the procedure. Diagnosis of AKI was, according to the Kidney Disease; Improving Global Outcomes (KDIGO) criteria (2012). Results: The mean age in the remote ischemic preconditioning (RIPC) group was 56.8 ± 11.4 years and 56.3 ± 11.8 years in the control group. We observed no significant difference regarding patient’s characteristic and renal biomarkers at baseline. There was no significant difference in the incidence of AKI (P = 0.116). The uNGAL increased by 36.2% 6-hour after the procedure in patients with AKI, while at the same time, this biomarker increased only by 4.3% in patients without AKI. Conclusion: We concluded that RIPC, with 3 cycles of 5-minute ischemia and 5-minute reperfusion, did not decrease CIN-AKI or altering renal biomarkers course in low-risk patients undergoing coronary angiography or PCI. Additionally, uNGAL, seems to be an appropriate biomarker for early diagnosis of CIN-AKI, 6 hours after contrast media exposure.

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P011 THE EARLY OUTCOMES OF ABDOMINAL WALL RECONSTRUCTION WITH POLYVINYLIDENE (PVDF) MESH IN THE INFECTED SETTING: A CASE-CONTROL SERIES

British Journal of Surgery ◽

10.1093/bjs/znab395.010 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Claudio Birolini ◽

Eduardo Tanaka ◽

Jocielle Miranda ◽

Abel Murakami ◽

Edivaldo Utiyama

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Synthetic Mesh ◽

Tissue Response ◽

Abdominal Wall Defects ◽

Chronic Infections ◽

Control Series ◽

Elective Setting ◽

Abdominal Operations ◽

Low Incidence

Abstract Aim The use of synthetic mesh to repair infected defects of the abdominal wall remains controversial. PVDF mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. Material and Methods A prospective clinical trial started in 2016 and designed to evaluate the short and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh reinforcement to treat their defects. Results Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and a longer operative and anesthesia time. At 30-days, surgical site occurrences were observed in 18 (47.4%) AI vs. 17 (44.7%) CC; surgical site infection occurred in 4 (10.4%) AI vs. 6 (15.8%) CC, and a higher number of procedural interventions were required in the CC group, 15.8% AI vs. 28.9% CC. At 6-months follow-up, no chronic infections or hernia recurrences were observed in both groups. Conclusions The use of PVDF mesh in the infected setting presented very favorable results with a low incidence of wound infection.

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Chest Wall Recurrence Rates for Low Risk Patients With Close/Positive Margins After Mastectomy for Breast Cancer, Treated With Reexcision and No Postmastectomy Radiation Therapy (PMRT)

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2015.07.667 ◽

2015 ◽

Vol 93 (3) ◽

pp. E49 ◽

Cited By ~ 1

Author(s):

J.S. Chang ◽

F. Wang ◽

C. Ewing ◽

M.D. Alvarado ◽

L. Esserman ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Chest Wall ◽

Low Risk ◽

Recurrence Rates ◽

Positive Margins ◽

Chest Wall Recurrence ◽

Postmastectomy Radiation ◽

Risk Patients ◽

Postmastectomy Radiation Therapy

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Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Endocrine Connections ◽

10.1530/ec-17-0312 ◽

2018 ◽

Vol 7 (1) ◽

pp. R26-R37 ◽

Cited By ~ 4

Author(s):

Nidan Qiao

Keyword(s):

Recurrence Rate ◽

Cushing’S Disease ◽

Meta Analysis ◽

Cushing's Disease ◽

Recurrence Rates ◽

Microscopic Surgery ◽

Significant Difference ◽

Comprehensive Search ◽

Definition Of

Introduction It is unclear whether the proportions of remission and the recurrence rates differ between endoscopic transsphenoidal surgery (TS) and microscopic TS in Cushing’s disease (CD); thus, we conducted a systematic review and meta-analysis to evaluate studies of endoscopic TS and microscopic TS. Methods We conducted a comprehensive search of PubMed to identify relevant studies. Remission and recurrence were used as outcome measures following surgical treatment of CD. Results A total of 24 cohort studies involving 1670 adult patients were included in the comparison. Among these studies, 702 patients across 9 studies underwent endoscopic TS, and 968 patients across 15 studies underwent microscopic TS. Similar baseline characteristics were observed in both groups. There was no significant difference in remission between the two groups: 79.7% (95% CI: 73.1–85.0%) in the endoscopic group and 76.9% (95% CI: 71.3–81.6%) in the microscopic group (P = 0.485). It appears that patients who underwent endoscopic surgery experience recurrence less often than patients who underwent microscopic surgery, with recurrence proportions of 11.0% and 15.9%, respectively (P = 0.134). However, if follow-up time is taken into account, both groups had a recurrence rate of approximately 4% per person per year (95% CI: 3.1–5.4% and 3.6–5.1%, P = 0.651). Conclusions We found that remission proportion and recurrence rate were the same in patients who underwent endoscopic TS as in patients who underwent microscopic TS. The definition of diagnosis, remission and recurrence should always be considered in the studies assessing therapeutic efficacy in CD.

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