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Unveiling The Role Of Mesh In Postoperative Pain Following Abdominal Wall Reconstruction: A Propensity-score Match Analysis
Maria J. Escobar Domingo, MD1, Valeria Bustos, MD, MS, MPH
2, Iulianna Taritsa, BA
1, Micaela Tobin, BA
1, Audrey Mustoe, BA
1, Agustin Posso, MD
1, Chamilka Merle, MD
1, Kyle Xu, MD
2, Bernard T. Lee, MD, MBA, MPH
1.
1Beth Israel Deaconess Medical Center, Boston, MA, USA,
2University of Miami, Miami, FL, USA.
PURPOSE:This study aims to assess the impact of mesh implantation on the development of acute and chronic postoperative pain in patients undergoing ventral hernia repair (VHR).
METHODS:A multicenter retrospective analysis was conducted using TriNetX to identify patients who underwent VHR. Patients were divided into two cohorts: those with concurrent mesh implantation (either synthetic or biological) and those without mesh. One-to-one nearest-neighbor propensity score matching was performed to adjust for baseline differences. The primary outcome was the incidence of postoperative pain at multiple time points. Group differences were analyzed using t-tests, chi-square tests, and logistic regression models.
RESULTS:After propensity score matching, 53,712 patients remained, evenly divided between the mesh and non-mesh cohorts. Patients with mesh implantation had similar odds of developing chronic postoperative pain at 6 months (OR 1.09; 95%CI0.96-1.25;p=0.19) and 1 year (OR 1.14; 95%CI 1.03-1.26;p=0.009). However, after two years, the odds of chronic pain became significantly higher in the mesh group (OR 1.21; 95%CI1.21;p<0.001), with this risk continuing to rise over time, up to 5 years postoperatively (OR 1.22; 95%CI1.22;p<0.001). Additionally, patients with mesh had higher rates of 90-day wound complications (8.8% vs.6.0%;p<0.001), emergency department visits (6.0% vs. 4.7%;p<0.001), and hospitalizations (9.9% vs. 7.4%;p<0.001).
CONCLUSION:Mesh implantation in VHR appears to be associated with a significantly increased risk of chronic postoperative pain beginning at two years postoperatively, with this risk continuing to rise over time.
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