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Drain vs no drain placement after retromuscular ventral hernia repair with mesh: an ACHQC analysis

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Abstract

Introduction

Ventral hernia repair (VHR) is one of the most common procedures in the United States, and drains are used in over 50% of mesh repairs. The aim of this study is to investigate the impact of drains on surgical site occurrences (SSO) and infection (SSI) after open and minimally invasive retromuscular VHR with mesh.

Methods

A retrospective review of prospectively collected data from the ACHQC was performed to include adult patients who underwent elective VHR with retromuscular mesh placement. Univariate analysis was performed comparing drain and no-drain groups. A logistic regression was performed to identify factors independently associated with increased SSO, SSI, readmission, and length of stay (LOS).

Results

6945 patients underwent elective VHR with sublay mesh. Most patients had M2 and M3 hernias in both groups (with Drain and no-drain). The median LOS was 4.7 (SD 8.3) in the drain group and 1.6 (SD 8.4) in the no-drain group (p < 0.001). 30-day SSI was higher in the drain group (176; 3.8% vs 25; 1.1%; p < 0.001). Despite lower SSO overall in the drain group (470; 10.0% vs 286; 12.7%; p < 0.001), SSO or SSI requiring intervention (SSOPI) was higher in the drain group (240; 5.1% vs 44; 1.9%; p < 0.001). Logistic regression identified diabetes (OR 1.3, CI 1.1–1.6; p < 0.001) and BMI (OR 1.04, CI 1.03–1.05; p < 0.001) as predictors of SSO, while the use of a drain was protective (OR 0.61; CI 0.5–0.8; p < 0.001). For SSI, logistic regression showed diabetes (OR 1.6, CI 1.2–2.3; p = 0.004) and open approach (OR 3.5, CI 2.1–5.9; p < 0.001) as predictors.

Conclusions

Drain placement during retromuscular VHR with mesh was predictive of decreased postoperative SSO occurrence but associated with increased LOS. Diabetes and open approach, but not drain use, were predictors of SSI.

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Authors and Affiliations

  1. Montefiore Medical Center, Bronx, NY, USA

    Diego Laurentino Lima, Shannon Keisling, Raquel Nogueira & Prashanth Sreeramoju

  2. Department of Population Health Sciences, Weill Cornell Medicine, New York, USA

    Xinyan Zheng

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  1. Diego Laurentino Lima
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  2. Shannon Keisling
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  3. Xinyan Zheng
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  4. Raquel Nogueira
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  5. Prashanth Sreeramoju
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Correspondence to Diego Laurentino Lima.

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Diego L Lima, Raquel Nogueira, Xinyan Zheng, Shannon Keisling, and Prashanth Sreeramoju have no conflicts of interest or financial ties to disclose.

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Lima, D.L., Keisling, S., Zheng, X. et al. Drain vs no drain placement after retromuscular ventral hernia repair with mesh: an ACHQC analysis. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-10871-2

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