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Risk Factors for Mesh-related Infections After Hernia Repair Surgery: A Meta-analysis of Cohort Studies

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Abstract

Mesh infection, although infrequent, is a devastating complication of mesh hernioplasties. The aim of this study was to systematically review and synthesize the available evidence on risk factors for synthetic mesh infection after hernioplasty. A systematic search was performed in PubMed and Scopus databases. The extracted data were synthesized with the methodology of meta-analysis. We identified six eligible studies that reported on 2,418 mesh hernioplasties. The crude mesh infection rate was 5%. Statistically significant risk factors were smoking (risk ratio [RR] = 1.36 [95% confidence interval (CI): 1.07, 1.73]; 1,171 hernioplasties), American Society of Anesthesiologists (ASA) score ≥3 (RR = 1.40 [1.15, 1.70]; 1,682 hernioplasties), and emergency operation (RR = 2.46 [1.56, 3.91]; 1,561 hernioplasties). Also, mesh infections were significantly correlated with patient age (weighted mean difference [WMD] = 2.63 [0.22, 5.04]; 2,364 hernioplasties), ASA score (WMD = 0.23 [0.08, 0.38]; 1,682 hernioplasties), and the duration of the hernioplasty (WMD = 44.92 [25.66, 64.18]; 833 hernioplasties). A trend toward higher mesh infection rates was observed in obese patients (RR = 1.41 [0.94, 2.11]; 2,243 hernioplasties) and in patients operated on by a resident (in contrast to a consultant; RR = 1.18 [0.99, 1.40]; 982 hernioplasties). Mesh infections usually resulted in mesh removal, and common pathogens included Staphylococcus spp., Enterococcus spp., and gram-negative bacteria. Patient age, ASA score, smoking, and the duration and emergency setting of the operation were found to be associated with the development of synthetic mesh infection. The heterogeneity of the available evidence should be taken under consideration. Prospective studies with a meticulous follow-up are warranted to further investigate mesh-related infections.

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Acknowledgments

The authors thank Prof. Mary T. Hawn for the kind offer of her article ahead of publication [44] and Dr. William S. Cobb for his kind provision of additional data on his article [13].

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The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23, Marousi, Athens, Greece

    Michael N. Mavros, Stavros Athanasiou, Vangelis G. Alexiou, Pantelis K. Mitsikostas, George Peppas & Matthew E. Falagas

  2. Department of Obstetrics and Gynecology, Athens University School of Medicine, Athens, Greece

    Stavros Athanasiou

  3. Department of Surgery, Northampton General Hospital, Northampton, UK

    Vangelis G. Alexiou

  4. Department of Surgery, Henry Dunant Hospital, Athens, Greece

    George Peppas

  5. Department of Medicine, Henry Dunant Hospital, Athens, Greece

    Matthew E. Falagas

  6. Department of Medicine, Tufts University School of Medicine, Boston, MA, USA

    Matthew E. Falagas

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  1. Michael N. Mavros
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Correspondence to Matthew E. Falagas.

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Mavros, M.N., Athanasiou, S., Alexiou, V.G. et al. Risk Factors for Mesh-related Infections After Hernia Repair Surgery: A Meta-analysis of Cohort Studies. World J Surg 35, 2389–2398 (2011). https://doi.org/10.1007/s00268-011-1266-5

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