Variation in mesh placement for ventral hernia repair: an opportunity for process improvement?

Abstract Background Incisional hernia repair (IHR) with mesh has been associated with decreased hernia recurrence. We analyzed variation in mesh use for IHR. Methods A cohort undergoing IHR from 16 Veterans' Administration (VA) Hospitals was identified. Patient-specific variables were obtained...

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Bibliographic Details
Published in:The American journal of surgery 2008-08, Vol.196 (2), p.201-206
Main Authors: Gray, Stephen H., M.D, Vick, Catherine C., M.S, Graham, Laura A., M.P.H, Finan, Kelly R., M.D., M.S.P.H, Neumayer, Leigh A., M.D., M.S, Hawn, Mary T., M.D., M.P.H., F.A.C.S
Format: Article
Language:English
Subjects:
Biological and medical sciences
Chronic obstructive pulmonary disease
Cohort Studies
Comorbidity
Confidence intervals
Demographics
Fasciotomy
Female
General aspects
Glucocorticoids - administration & dosage
Hernia, Ventral - surgery
Hernias
Hospitals
Hospitals, Veterans
Humans
Incisional hernia repair
Intestines - surgery
Logistics
Male
Medical sciences
Middle Aged
Multivariate Analysis
Polypropylenes
Polytetrafluoroethylene
Population
Prostheses
Quality
Recurrence
Retrospective Studies
Studies
Surgery
Surgical Mesh
United States
Variables
Variation
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Summary:Abstract Background Incisional hernia repair (IHR) with mesh has been associated with decreased hernia recurrence. We analyzed variation in mesh use for IHR. Methods A cohort undergoing IHR from 16 Veterans' Administration (VA) Hospitals was identified. Patient-specific variables were obtained from National Surgical Quality Improvement Program (NSQIP) data. Operative variables were obtained from physician-abstracted operative notes. Univariate and multivariable logistic regression analyses were used to model mesh implantation predictors. Results A total of 1,123 IHR cases were analyzed; Mesh was implanted in 69.6% (n = 781). Regression models demonstrated repair at a high performing facility was associated with a nearly 4-fold increase in mesh utilization. Other significant predictors include repair of recurrent hernia, chronic steroid use, and multiple fascial defects. Conclusions There is variation in the rate of mesh placement for IHR by VA facility, even after accounting for key explanatory variables. Patterns of mesh placement in IHR appear to be based on practice style.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2007.09.041