Outcomes of light and midweight synthetic mesh use in clean-contaminated and contaminated ventral incisional hernia repair: an ACHQC comparative analysis
Background Use of macroporous synthetic mesh in contaminated ventral hernia repair has become more frequent. The objective of this study is to compare the outcomes of ventral incisional hernia repair with permanent synthetic mesh in contaminated fields to those in a clean field. Methods The Abdomina...
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| Veröffentlicht in: | Surgical endoscopy 2023-07, Vol.37 (7), p.5583-5590 |
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| creator | Polcz, Monica E. Pierce, Richard A. Olson, Molly A. Blankush, Joseph Duke, Meredith C. Broucek, Joseph Bradley, Joel F. |
| description | Background
Use of macroporous synthetic mesh in contaminated ventral hernia repair has become more frequent. The objective of this study is to compare the outcomes of ventral incisional hernia repair with permanent synthetic mesh in contaminated fields to those in a clean field.
Methods
The Abdominal Core Health Quality Collaborative registry, a prospectively updated longitudinal hernia-specific national database, was retrospectively queried for adults who underwent open ventral incisional hernia repair using light or medium-weight synthetic mesh and classified as clean (CDC Class I) or contaminated (CDC Class II/III). Univariate analysis was used to compare demographic information, hernia characteristics, and operative details. Odds ratios (OR) were calculated using multivariable logistic regression for the primary outcome of 30-day surgical site infection (SSI) and secondary outcomes of 30-day surgical site occurrence (SSO), SSO requiring procedural intervention (SSO-PI), and clinical recurrence at one year.
Results
7219 cases met criteria for inclusion; 13.2% of these were contaminated. 83.4% of patients had follow-up data at 30 days and 20.8% at 1 year. The adjusted OR for 30-day SSI in contaminated fields compared to clean was 2.603 (95% CI 1.959–3.459). OR for 30-day SSO was 1.275 (95% CI 1.017–1.600) and 2.355 (95%CI 1.817–3.053) for 30-day SSO-PI. OR for recurrence at one year was 1.489 (95%CI 0.892–2.487). Contaminated cases had higher rates of mesh infection (3.9% vs 0.8%,
p
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| doi_str_mv | 10.1007/s00464-022-09739-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2731429527</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2833354810</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-ea7c7dbe0c288d13520162fcbf6d8c0c56d0d7d1d19a828188e1bddd9e2236d23</originalsourceid><addsrcrecordid>eNp9kc9uEzEQxi0EoiHlBXqoLHHhYvCf3bXdWxUVilSpQqJny7FnG1e73tT2tsqj9G1xkwKCA6exZ37fNyN9CJ0w-olRKj9nSpuuIZRzQrUUmtBXaMEawQnnTL1GC6oFJVzq5gi9y_mOVl6z9i06Ep1gWmm5QE_Xc3HTCBlPPR7C7aZgGz0eg3-E_S_vYtlACQ5XaIPnDDhE7AawkbgpFjuGaAv4veyvxgPEkuxQcRdymGJ9biDFYHGCrQ3prErw-ery-6rqxq1NtoQHqE077HLIx-hNb4cM71_qEt18ufixuiRX11-_rc6viBOyLQSsdNKvgTqulGei5ZR1vHfrvvPKUdd2nnrpmWfaKq6YUsDW3nsNnIvOc7FEHw--2zTdz5CLGUN2MAw2wjRnw6VgDddtrUv04R_0bppTvbdSSgjRNorRSvED5dKUc4LebFMYbdoZRs1zcOYQnKnBmX1w5ll0-mI9r0fwvyW_kqqAOAC5juItpD-7_2P7Ewkepik</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2833354810</pqid></control><display><type>article</type><title>Outcomes of light and midweight synthetic mesh use in clean-contaminated and contaminated ventral incisional hernia repair: an ACHQC comparative analysis</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Polcz, Monica E. ; Pierce, Richard A. ; Olson, Molly A. ; Blankush, Joseph ; Duke, Meredith C. ; Broucek, Joseph ; Bradley, Joel F.</creator><creatorcontrib>Polcz, Monica E. ; Pierce, Richard A. ; Olson, Molly A. ; Blankush, Joseph ; Duke, Meredith C. ; Broucek, Joseph ; Bradley, Joel F.</creatorcontrib><description>Background
Use of macroporous synthetic mesh in contaminated ventral hernia repair has become more frequent. The objective of this study is to compare the outcomes of ventral incisional hernia repair with permanent synthetic mesh in contaminated fields to those in a clean field.
Methods
The Abdominal Core Health Quality Collaborative registry, a prospectively updated longitudinal hernia-specific national database, was retrospectively queried for adults who underwent open ventral incisional hernia repair using light or medium-weight synthetic mesh and classified as clean (CDC Class I) or contaminated (CDC Class II/III). Univariate analysis was used to compare demographic information, hernia characteristics, and operative details. Odds ratios (OR) were calculated using multivariable logistic regression for the primary outcome of 30-day surgical site infection (SSI) and secondary outcomes of 30-day surgical site occurrence (SSO), SSO requiring procedural intervention (SSO-PI), and clinical recurrence at one year.
Results
7219 cases met criteria for inclusion; 13.2% of these were contaminated. 83.4% of patients had follow-up data at 30 days and 20.8% at 1 year. The adjusted OR for 30-day SSI in contaminated fields compared to clean was 2.603 (95% CI 1.959–3.459). OR for 30-day SSO was 1.275 (95% CI 1.017–1.600) and 2.355 (95%CI 1.817–3.053) for 30-day SSO-PI. OR for recurrence at one year was 1.489 (95%CI 0.892–2.487). Contaminated cases had higher rates of mesh infection (3.9% vs 0.8%,
p
< 0.001) and mesh removal (7.3 vs 2.5%,
p
< 0.001) at 1 year.
Conclusions
After adjusting for baseline differences, patients undergoing ventral incisional hernia repair using light or midweight synthetic mesh in contaminated fields have higher odds of 30-day SSI, SSO, and SSO-PI than those performed in clean wounds. The odds of recurrence did not statistically differ and further studies with long-term outcomes are needed to better evaluate the best treatment options for this patient population.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-022-09739-0</identifier><identifier>PMID: 36319897</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>2022 SAGES Oral ; Abdomen ; Abdominal Surgery ; Adult ; Chronic obstructive pulmonary disease ; Collaboration ; Comparative analysis ; Diabetes ; Disease control ; Endoscopy ; Gastroenterology ; Gynecology ; Hepatology ; Hernia, Ventral - surgery ; Hernias ; Herniorrhaphy - adverse effects ; Humans ; Incisional Hernia - etiology ; Incisional Hernia - surgery ; Light ; Medicine ; Medicine & Public Health ; Neoplasm Recurrence, Local - surgery ; Nicotine ; Obstetrics ; Proctology ; Recurrence ; Regression analysis ; Retrospective Studies ; Small intestine ; Surgery ; Surgical Mesh - adverse effects ; Surgical site infections ; Surgical Wound Infection - epidemiology ; Surgical Wound Infection - etiology ; Surgical Wound Infection - surgery ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2023-07, Vol.37 (7), p.5583-5590</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-ea7c7dbe0c288d13520162fcbf6d8c0c56d0d7d1d19a828188e1bddd9e2236d23</citedby><cites>FETCH-LOGICAL-c375t-ea7c7dbe0c288d13520162fcbf6d8c0c56d0d7d1d19a828188e1bddd9e2236d23</cites><orcidid>0000-0001-6452-8013</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-022-09739-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-022-09739-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36319897$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Polcz, Monica E.</creatorcontrib><creatorcontrib>Pierce, Richard A.</creatorcontrib><creatorcontrib>Olson, Molly A.</creatorcontrib><creatorcontrib>Blankush, Joseph</creatorcontrib><creatorcontrib>Duke, Meredith C.</creatorcontrib><creatorcontrib>Broucek, Joseph</creatorcontrib><creatorcontrib>Bradley, Joel F.</creatorcontrib><title>Outcomes of light and midweight synthetic mesh use in clean-contaminated and contaminated ventral incisional hernia repair: an ACHQC comparative analysis</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Use of macroporous synthetic mesh in contaminated ventral hernia repair has become more frequent. The objective of this study is to compare the outcomes of ventral incisional hernia repair with permanent synthetic mesh in contaminated fields to those in a clean field.
Methods
The Abdominal Core Health Quality Collaborative registry, a prospectively updated longitudinal hernia-specific national database, was retrospectively queried for adults who underwent open ventral incisional hernia repair using light or medium-weight synthetic mesh and classified as clean (CDC Class I) or contaminated (CDC Class II/III). Univariate analysis was used to compare demographic information, hernia characteristics, and operative details. Odds ratios (OR) were calculated using multivariable logistic regression for the primary outcome of 30-day surgical site infection (SSI) and secondary outcomes of 30-day surgical site occurrence (SSO), SSO requiring procedural intervention (SSO-PI), and clinical recurrence at one year.
Results
7219 cases met criteria for inclusion; 13.2% of these were contaminated. 83.4% of patients had follow-up data at 30 days and 20.8% at 1 year. The adjusted OR for 30-day SSI in contaminated fields compared to clean was 2.603 (95% CI 1.959–3.459). OR for 30-day SSO was 1.275 (95% CI 1.017–1.600) and 2.355 (95%CI 1.817–3.053) for 30-day SSO-PI. OR for recurrence at one year was 1.489 (95%CI 0.892–2.487). Contaminated cases had higher rates of mesh infection (3.9% vs 0.8%,
p
< 0.001) and mesh removal (7.3 vs 2.5%,
p
< 0.001) at 1 year.
Conclusions
After adjusting for baseline differences, patients undergoing ventral incisional hernia repair using light or midweight synthetic mesh in contaminated fields have higher odds of 30-day SSI, SSO, and SSO-PI than those performed in clean wounds. The odds of recurrence did not statistically differ and further studies with long-term outcomes are needed to better evaluate the best treatment options for this patient population.</description><subject>2022 SAGES Oral</subject><subject>Abdomen</subject><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Collaboration</subject><subject>Comparative analysis</subject><subject>Diabetes</subject><subject>Disease control</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hernia, Ventral - surgery</subject><subject>Hernias</subject><subject>Herniorrhaphy - adverse effects</subject><subject>Humans</subject><subject>Incisional Hernia - etiology</subject><subject>Incisional Hernia - surgery</subject><subject>Light</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Nicotine</subject><subject>Obstetrics</subject><subject>Proctology</subject><subject>Recurrence</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Small intestine</subject><subject>Surgery</subject><subject>Surgical Mesh - adverse effects</subject><subject>Surgical site infections</subject><subject>Surgical Wound Infection - epidemiology</subject><subject>Surgical Wound Infection - etiology</subject><subject>Surgical Wound Infection - surgery</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc9uEzEQxi0EoiHlBXqoLHHhYvCf3bXdWxUVilSpQqJny7FnG1e73tT2tsqj9G1xkwKCA6exZ37fNyN9CJ0w-olRKj9nSpuuIZRzQrUUmtBXaMEawQnnTL1GC6oFJVzq5gi9y_mOVl6z9i06Ep1gWmm5QE_Xc3HTCBlPPR7C7aZgGz0eg3-E_S_vYtlACQ5XaIPnDDhE7AawkbgpFjuGaAv4veyvxgPEkuxQcRdymGJ9biDFYHGCrQ3prErw-ery-6rqxq1NtoQHqE077HLIx-hNb4cM71_qEt18ufixuiRX11-_rc6viBOyLQSsdNKvgTqulGei5ZR1vHfrvvPKUdd2nnrpmWfaKq6YUsDW3nsNnIvOc7FEHw--2zTdz5CLGUN2MAw2wjRnw6VgDddtrUv04R_0bppTvbdSSgjRNorRSvED5dKUc4LebFMYbdoZRs1zcOYQnKnBmX1w5ll0-mI9r0fwvyW_kqqAOAC5juItpD-7_2P7Ewkepik</recordid><startdate>20230701</startdate><enddate>20230701</enddate><creator>Polcz, Monica E.</creator><creator>Pierce, Richard A.</creator><creator>Olson, Molly A.</creator><creator>Blankush, Joseph</creator><creator>Duke, Meredith C.</creator><creator>Broucek, Joseph</creator><creator>Bradley, Joel F.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6452-8013</orcidid></search><sort><creationdate>20230701</creationdate><title>Outcomes of light and midweight synthetic mesh use in clean-contaminated and contaminated ventral incisional hernia repair: an ACHQC comparative analysis</title><author>Polcz, Monica E. ; Pierce, Richard A. ; Olson, Molly A. ; Blankush, Joseph ; Duke, Meredith C. ; Broucek, Joseph ; Bradley, Joel F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-ea7c7dbe0c288d13520162fcbf6d8c0c56d0d7d1d19a828188e1bddd9e2236d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>2022 SAGES Oral</topic><topic>Abdomen</topic><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Collaboration</topic><topic>Comparative analysis</topic><topic>Diabetes</topic><topic>Disease control</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hernia, Ventral - surgery</topic><topic>Hernias</topic><topic>Herniorrhaphy - adverse effects</topic><topic>Humans</topic><topic>Incisional Hernia - etiology</topic><topic>Incisional Hernia - surgery</topic><topic>Light</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Nicotine</topic><topic>Obstetrics</topic><topic>Proctology</topic><topic>Recurrence</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Small intestine</topic><topic>Surgery</topic><topic>Surgical Mesh - adverse effects</topic><topic>Surgical site infections</topic><topic>Surgical Wound Infection - epidemiology</topic><topic>Surgical Wound Infection - etiology</topic><topic>Surgical Wound Infection - surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Polcz, Monica E.</creatorcontrib><creatorcontrib>Pierce, Richard A.</creatorcontrib><creatorcontrib>Olson, Molly A.</creatorcontrib><creatorcontrib>Blankush, Joseph</creatorcontrib><creatorcontrib>Duke, Meredith C.</creatorcontrib><creatorcontrib>Broucek, Joseph</creatorcontrib><creatorcontrib>Bradley, Joel F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Polcz, Monica E.</au><au>Pierce, Richard A.</au><au>Olson, Molly A.</au><au>Blankush, Joseph</au><au>Duke, Meredith C.</au><au>Broucek, Joseph</au><au>Bradley, Joel F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of light and midweight synthetic mesh use in clean-contaminated and contaminated ventral incisional hernia repair: an ACHQC comparative analysis</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2023-07-01</date><risdate>2023</risdate><volume>37</volume><issue>7</issue><spage>5583</spage><epage>5590</epage><pages>5583-5590</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Use of macroporous synthetic mesh in contaminated ventral hernia repair has become more frequent. The objective of this study is to compare the outcomes of ventral incisional hernia repair with permanent synthetic mesh in contaminated fields to those in a clean field.
Methods
The Abdominal Core Health Quality Collaborative registry, a prospectively updated longitudinal hernia-specific national database, was retrospectively queried for adults who underwent open ventral incisional hernia repair using light or medium-weight synthetic mesh and classified as clean (CDC Class I) or contaminated (CDC Class II/III). Univariate analysis was used to compare demographic information, hernia characteristics, and operative details. Odds ratios (OR) were calculated using multivariable logistic regression for the primary outcome of 30-day surgical site infection (SSI) and secondary outcomes of 30-day surgical site occurrence (SSO), SSO requiring procedural intervention (SSO-PI), and clinical recurrence at one year.
Results
7219 cases met criteria for inclusion; 13.2% of these were contaminated. 83.4% of patients had follow-up data at 30 days and 20.8% at 1 year. The adjusted OR for 30-day SSI in contaminated fields compared to clean was 2.603 (95% CI 1.959–3.459). OR for 30-day SSO was 1.275 (95% CI 1.017–1.600) and 2.355 (95%CI 1.817–3.053) for 30-day SSO-PI. OR for recurrence at one year was 1.489 (95%CI 0.892–2.487). Contaminated cases had higher rates of mesh infection (3.9% vs 0.8%,
p
< 0.001) and mesh removal (7.3 vs 2.5%,
p
< 0.001) at 1 year.
Conclusions
After adjusting for baseline differences, patients undergoing ventral incisional hernia repair using light or midweight synthetic mesh in contaminated fields have higher odds of 30-day SSI, SSO, and SSO-PI than those performed in clean wounds. The odds of recurrence did not statistically differ and further studies with long-term outcomes are needed to better evaluate the best treatment options for this patient population.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>36319897</pmid><doi>10.1007/s00464-022-09739-0</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-6452-8013</orcidid></addata></record> |
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| ispartof | Surgical endoscopy, 2023-07, Vol.37 (7), p.5583-5590 |
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| source | MEDLINE; SpringerNature Journals |
| subjects | 2022 SAGES Oral Abdomen Abdominal Surgery Adult Chronic obstructive pulmonary disease Collaboration Comparative analysis Diabetes Disease control Endoscopy Gastroenterology Gynecology Hepatology Hernia, Ventral - surgery Hernias Herniorrhaphy - adverse effects Humans Incisional Hernia - etiology Incisional Hernia - surgery Light Medicine Medicine & Public Health Neoplasm Recurrence, Local - surgery Nicotine Obstetrics Proctology Recurrence Regression analysis Retrospective Studies Small intestine Surgery Surgical Mesh - adverse effects Surgical site infections Surgical Wound Infection - epidemiology Surgical Wound Infection - etiology Surgical Wound Infection - surgery Treatment Outcome |
| title | Outcomes of light and midweight synthetic mesh use in clean-contaminated and contaminated ventral incisional hernia repair: an ACHQC comparative analysis |
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