(Poster 122) Concurrent Mesh Hernia Repair with Colpopexy; The General Surgeon’s Perspective

Objectives: Our aim was to detect differences in major complications when concurrent mesh hernia repair was performed during apical suspension procedures compared to isolated mesh hernia repairs.

Methods: Three hundred and thirty eight of 204,432 isolated mesh hernia repair patients abstracted from the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP) database were randomly selected for comparison with all patients who underwent a concurrent mesh hernia repair during an apical suspension procedure for pelvic organ prolapse (2:1 ratio). Clinical differences in our patients were compared using Chi-square and independent T-tests for population proportions, and means, respectively. Our primary outcome of interest was at least 1 major complication defined as any complication other than UTI or superficial SSI. We tested our null hypothesis of no difference in major complications between concurrent and isolated mesh hernia repair (p < 0.05) using Chi-square test for associations. Post hoc power analyses were conducted where appropriate. Independent predictors of major complications were analyzed with binary logistic regression analysis.

Results: There were 169 patients who underwent concurrent mesh hernia repairs. One hundred and seven (63.3%) of the apical suspension procedures were laparoscopic sacrocolopexy, 22 (13%) were abdominal sacrocolpopexy, 18 (10.7%) were intra-peritoneal colpopexy, and 22 (13%) were extra-peritoneal colpopexy. Hysterectomy was performed in 47 (27.8%) of the apical suspension procedures. Clinical differences between our retrospective cohort are shown in table 1. Major complications were rare, occurring in 22 (4.3%) of the total cohort. We found no difference in the rate of major complications comparing concurrent with isolated mesh hernia repairs (5.3% vs 3.8%, p = 0.44). Eliminating hysterectomy as a confounder reduced the major complication rate to 4.9% in the concurrent mesh hernia repair patients. Our post hoc power to detect a higher rate of major complications after concurrent mesh hernia repair was 9.3% A total of 2322 concurrent mesh hernia vs 4644 isolated repairs would need to be abstracted from the database to detect an absolute risk difference of 1.5% (RR 1.40) with 80% power. Independent clinical predictors of major complications were age (OR 1.05 95%CI 1.002, 1.10), current smoker (OR 3.56, 95%CI 1.05, 12.03), total operating room time (OR 1.007, 95%CI 1.001, 1.013), and BMI (OR 1.07, 95%CI 1.005, 1.13).

Conclusions: We find no reason to deny patients with “pelvic hernias” the opportunity to have concurrent mesh hernia repairs by willing general surgeons given the small difference (1.5%) in the major complication rate even when hysterectomy is performed. Smoking should be recognized as the driver of major complications and be stopped 4-6 weeks prior and 4 weeks after surgery based on American College of Surgeons recommendations. Figure Legend: *Steroid use and Severe COPD covary therefore only steroid use was entered into regression analysis.