The American Journal of Surgery
Volume 196, Issue 2 , Pages 201-206, August 2008

Variation in mesh placement for ventral hernia repair: an opportunity for process improvement?

  • Stephen H. Gray, M.D.

      Affiliations

    • Deep South Center for Effectiveness Research, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL, USA
    • Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
    • Health Services and Outcomes Research Training Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
    • ,
  • Catherine C. Vick, M.S.

      Affiliations

    • Deep South Center for Effectiveness Research, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL, USA
    • Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
    • ,
  • Laura A. Graham, M.P.H.

      Affiliations

    • Deep South Center for Effectiveness Research, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL, USA
    • ,
  • Kelly R. Finan, M.D., M.S.P.H.

      Affiliations

    • Deep South Center for Effectiveness Research, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL, USA
    • Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
    • ,
  • Leigh A. Neumayer, M.D., M.S.

      Affiliations

    • VA Medical Center and Department of Surgery, University of Utah, Salt Lake City, UT, USA
    • ,
  • Mary T. Hawn, M.D., M.P.H., F.A.C.S.

      Affiliations

    • Deep South Center for Effectiveness Research, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL, USA
    • Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1-205-975-1932; fax: +1-205-996-4959.

Received 15 August 2007; received in revised form 30 August 2007 published online 30 May 2008.

Abstract 

Background

Incisional hernia repair (IHR) with mesh has been associated with decreased hernia recurrence. We analyzed variation in mesh use for IHR.

Methods

A cohort undergoing IHR from 16 Veterans' Administration (VA) Hospitals was identified. Patient-specific variables were obtained from National Surgical Quality Improvement Program (NSQIP) data. Operative variables were obtained from physician-abstracted operative notes. Univariate and multivariable logistic regression analyses were used to model mesh implantation predictors.

Results

A total of 1,123 IHR cases were analyzed; Mesh was implanted in 69.6% (n = 781). Regression models demonstrated repair at a high performing facility was associated with a nearly 4-fold increase in mesh utilization. Other significant predictors include repair of recurrent hernia, chronic steroid use, and multiple fascial defects.

Conclusions

There is variation in the rate of mesh placement for IHR by VA facility, even after accounting for key explanatory variables. Patterns of mesh placement in IHR appear to be based on practice style.

Keywords: Incisional hernia repair, Variation, Quality

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 Supported by the Health Services Research and Development Program of the Department of Veterans Affairs Office of Research and Development and Grant No. 5 T32 HS013852 from the Agency for Healthcare Research and Quality.

PII: S0002-9610(08)00249-3

doi:10.1016/j.amjsurg.2007.09.041

The American Journal of Surgery
Volume 196, Issue 2 , Pages 201-206, August 2008

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