Does prior mesh infection matter? Clinical outcomes of patients undergoing complex abdominal wall reconstruction after infected mesh explantation.

Background: While mesh infection after ventral hernia repair often requires explantation and subsequent repair, the association between prior mesh infection with outcomes following complex abdominal wall reconstruction remains poorly understood.

Methods: A two-stage propensity score-matched analysis was performed using the Abdominal Core Health Quality Collaborative database. Patients undergoing clean, elective, open ventral hernia repair with prior mesh infections were compared with those with no prior wound morbidity and non-mesh-related surgical site infections (SSIs). All patients underwent elective open ventral hernia repair with transversus abdominis release (TAR) and retromuscular synthetic mesh placement.

Results: After propensity score matching, 205 patients with prior mesh infection were matched to 205 patients with prior non-mesh-related SSI and to 548 patients with no prior wound morbidity. Patients with a prior mesh infection experienced significantly higher rates of 30-day surgical site occurrences (SSO) (24.9% vs. 14.1%; p < 0.001) and surgical site occurrences requiring procedural intervention (14.1% vs. 7.7%; p = 0.007), compared with those with no prior wound morbidity. Compared with those with prior non-mesh-related SSIs, patients with a prior mesh infection also had a higher rate of SSO (25% vs. 14%; p = 0.004) and a higher proportion of deep SSIs (65% vs. 20%; p = 0.004). Despite these differences, mesh excision rates were low across all groups (0.1-0.2%). Patients with prior mesh infection reported significantly worse quality of life at baseline (median HerQLes: 22 vs. 32; p = 0.008) and worse pain scores at 30 days (median PROMIS 3 A: 52 vs. 46; p = 0.007). Reoperation and hernia recurrence rates were similar between groups throughout the five-year follow-up period.

Conclusions: Prior mesh infection is associated with increased short-term wound morbidity following complex abdominal wall reconstruction, despite similar long-term hernia recurrence rates and low rates of mesh excision. While transversus abdominis release (TAR) with retromuscular mesh placement may mitigate the risk of repeated mesh infection and explantation, prior mesh infections impact patient outcomes well beyond the immediate postoperative period. These findings can help guide informed discussion and set appropriate patient expectations.