Evidence map›Paper›PMID 35851814›Full record

ArticleSurgical endoscopy2023

Hospital-level variation in mesh use for ventral and incisional hernia repair.

Ryan Howard, Anne Ehlers, Lia Delaney, Quintin Solano, Mary Shen, Michael Englesbe, Justin Dimick, Dana Telem

Abstract read
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Article in Surgical endoscopy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Ryan HowardDepartment of Surgery, University of Michigan, Ann Arbor, MI, USA.ORCID http://orcid.org/0000-0001-9877-9603
Anne EhlersDepartment of Surgery, University of Michigan, Ann Arbor, MI, USA.
Lia DelaneyUniversity of Michigan Medical School, Ann Arbor, MI, USA.
Quintin SolanoUniversity of Michigan Medical School, Ann Arbor, MI, USA.
Mary ShenDepartment of Surgery, University of Michigan, Ann Arbor, MI, USA.
Michael EnglesbeDepartment of Surgery, University of Michigan, Ann Arbor, MI, USA.
Justin DimickDepartment of Surgery, University of Michigan, Ann Arbor, MI, USA.
Dana TelemDepartment of Surgery, University of Michigan, Ann Arbor, MI, USA. dtelem@med.umich.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPlacement of prosthetic mesh during ventral and incisional hernia repair has been shown to reduce the incidence of postoperative hernia recurrence. Consequently, multiple consensus guidelines recommend the use of mesh for ventral hernias of any size. However, the extent to which real-world practice patterns reflect these recommendations is unclear.

methodsWe performed a retrospective review of the Michigan Surgical Quality Collaborative Hernia Registry (MSQC-HR) to identify patients undergoing clean ventral or incisional hernia repair between January 1, 2020 and December 31, 2021. The primary outcome was mesh use. We used two-step hierarchical logistic regression modeling with empirical Bayes estimates to evaluate the association of hospital-level mesh use with patient, operative, and hernia characteristics.

resultsA total of 5262 patients underwent ventral and incisional hernia repair at 65 hospitals with a mean age of 53.8 (14.5) years, 2292 (43.6%) females, and a mean hernia width of 3.2 (3.4) cm. Mean hospital volume was 81 (49) cases. Mesh was used in 4098 (77.9%) patients. At the patient level, hernia width and surgical approach were significantly associated with mesh use. Specifically, mesh use was 6.2% (95% CI 4.8-7.5%) more likely with each additional centimeter of hernia width and 28.0% (95% CI 26.1-29.8%) more likely for minimally invasive repair compared to open repair. At the hospital level, there was wide variation in mesh use, ranging from 38.0% (95% CI 31.5-44.9%) to 96.4% (95% CI 95.3-97.2%). Hospital-level mesh use was not associated with differences in hernia size (β =  - 0.003, P = 0.978), surgical approach (β =  - 1.109, P = 0.414), or any other patient factors.

conclusionsDespite strong evidence supporting the use of mesh in ventral and incisional hernia repair, there is substantial variation in mesh use between hospitals that is not explained by differences in patient characteristics or operative approach. This suggests that opportunities exist to standardize surgical practice to better align with evidence supporting the use of mesh in the management of these hernias.

Indexed as

Hernia, VentralIncisional HerniaLaparoscopyBayes TheoremFemaleHerniorrhaphyHumansMaleMiddle AgedRecurrenceSurgical MeshBest practiceHerniaMeshPractice improvementVariation

Identifiers

PMID35851814

What OpenQuestion holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.