Systematic review and meta-analysis of risk factors for Mesh infection following Abdominal Wall Hernia Repair Surgery

• Published in: The American journal of surgery Vol. 224; no. 1; pp. 239 - 246
• Main Authors: Quiroga-Centeno, Andrea Carolina, Quiroga-Centeno, Carlos Augusto, Guerrero-Macías, Silvia, Navas-Quintero, Orlando, Gómez-Ochoa, Sergio Alejandro
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2022; Elsevier Limited
• Subjects: Abdomen; Abdominal wall; Bias; Context; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Health risks; Hernia; Hernias; Infection; Infections; Laparoscopy; Mesh; Meta-analysis; Multivariate analysis; Risk analysis; Risk factors; Sensitivity analysis; Steroid hormones; Surgery; Surgical mesh; Surgical site infections; Systematic review; Hernia; Infection; Abdominal wall; Mesh; Risk factors
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2021.12.024

Surgical Mesh Infection (SMI) after Abdominal Wall Hernia Repair (AWHR) represents a catastrophic complication. We performed a systematic review and meta-analysis to analyze the risk factors for SMI in the context of AWHR.
PubMed, Embase, Scielo, and LILACS were searched without language or time restrictions from inception until June 2021. Articles evaluating the association between demographic, clinical, laboratory and surgical characteristics with SMI in AWHR were included.
23 studies were evaluated, comprising a total of 118,790 patients (98% males; mean age 56.5 years) with a mesh infection pooled prevalence of 4%. Significant risk factors for SMI were type 2 diabetes mellitus, obesity, smoking history, steroids use, ASA III/IV, laparotomy vs laparoscopy, emergency surgery, duration of surgery and onlay mesh position vs sublay. The quality of evidence was regarded as very low–moderate.
Several factors, highlighting sociodemographic characteristics, comorbidities, and the clinical scenario, may increase the risk of developing mesh infections in AWHR. The recognition and mitigation of these may significantly reduce mesh infection rates in this context.
Risk factors for Mesh infection following abdominal wall Hernia repair surgery. [Display omitted]
•Surgical mesh infection (SMI) is a devastating complication in hernia repair.•The main risk factors for SMI are open and emergency surgery, and onlay position.•Other identified risk factors are prolonged surgery, obesity, steroids use, ASA status and diabetes.•The identification of high-risk patients may contribute to mitigation of SMI impact.