Table 2.
Description of the conservative treatment subgroup, comparison of patients without or with treatment failure, and determinants of treatment failure (univariate analysis)
| Conservative treatment | Descriptive analysis | Univariate analysis | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Failure | Success | p-value | OR (95% CI) | p-value | |||||
| n | 131 | 54 | 77 | ||||||
| Demographics and comorbidities | |||||||||
| Gender (male) | 74/131 (56.5%) | 32/54 (59.3%) | 42/77 (54.5%) | 0.592 | 1.212 (0.599–2.451) | 0.592 | |||
| Age (years) | 62 (55–69) | 61.5 (55.3–69.8) | 62 (54.5–69) | 0.924 | 1.006 (0.976–1.036) | 0.681 | |||
| BMI (kg/m²) | 29.7 (26.9–33.2) | 29.1 (26.8–32.6) | 30.1 (26-33.6) | 0.680 | 0.993 (0.937–1.052) | 0.825 | |||
| ASA score | 2 (2–3) | 2 (2–3) | 2 (2–3) | 0.825 | 0.965 (0.547–1.704) | 0.904 | |||
| Modified Charlson’s Comorbidity index | 3 (2-4.5) | 3 (2–4) | 3 (2–5) | 0.945 | 1.003 (0.868–1.157) | 0.966 | |||
| Active smoking | 25/131 (19.1%) | 11/54 (20.4%) | 14/77 (18.2%) | 0.754 | 1.151 (0.477–2.774) | 0.753 | |||
| Previous abdominal surgery | 126/131 (96.2%) | 51/54 (94.4%) | 75/77 (97.4%) | 0.403 | 0.453 (0.073–2.809) | 0.395 | |||
| > 1 previous abdominal surgeries | 100/131 (76.3%) | 48/54 (88.9%) | 52/77 (67.5%) | 0.005 | 3.846 (1.452–10.182) | 0.006 | |||
| Index surgery | |||||||||
| Operative indication | |||||||||
| Primary hernia | 23/129 (17.8%) | 11/53 (20.8%) | 12/76 (15.8%) | 0.469 | 1.396 (0.564–3.456) | 0.469 | |||
| Incisional hernia | 102/129 (79.1%) | 39/53 (73.6%) | 63/76 (82.9%) | 0.201 | 0.574 (0.244–1.350) | 0.203 | |||
| Acute complication | 6/129 (4.7%) | 3/53 (5.7%) | 3/76 (3.9%) | 0.689 | 1.459 (0.283–7.528) | 0.651 | |||
| Post-surgical parietal closure | 4/129 (3.1%) | 3/53 (5.7%) | 1/76 (1.3%) | 0.305 | 4.499 (0.455–44.494) | 0.198 | |||
| Mesh characteristics | |||||||||
| Size (cm²) | 500 (288–900) | 500 (300–900) | 450 (0-900) | 0.301 | 1.000 (0.999–1.001) | 0.178 | |||
| Synthetic | 82/115 (71.3%) | 32/49 (65.3%) | 50/66 (75.8%) | 0.220 | 0.602 (0.266–1.359) | 0.222 | |||
| Biosynthetic | 32/115 (27.8%) | 17/49 (34.7%) | 15/66 (22.7%) | 0.157 | 1.806 (0.793–4.113) | 0.159 | |||
| Biological | 1/115 (0.9%) | 0/49 (0%) | 1/66 (1.5%) | 1.000 | |||||
| Absorbable | 29/116 (25%) | 14/49 (28.6%) | 15/67 (22.4%) | 0.447 | 1.386 (0.595–3.228) | 0.448 | |||
| Semi-absorbable | 35/116 (30.2%) | 11/49 (22.4%) | 24/67 (35.8%) | 0.121 | 0.518 (0.224–1.197) | 0.123 | |||
| Non-absorbable | 52/116 (44.8%) | 24/49 (49.0%) | 28/67 (41.8%) | 0.442 | 1.337 (0.637–2.805) | 0.442 | |||
| Mesh location | |||||||||
| Subcutaneous | 25/127 (19.7%) | 11/52 (21.2%) | 14/75 (18.7%) | 0.729 | 1.168 (0.483–2.827) | 0.729 | |||
| Retromuscular | 62/127 (48.8%) | 19/52 (36.5%) | 43/75 (57.3%) | 0.021 | 0.428 (0.207–0.886) | 0.022 | |||
| Preperitoneal | 8/127 (6.3%) | 4/52 (7.7%) | 4/75 (5.3%) | 0.715 | 1.479 (0.352–6.202) | 0.592 | |||
| Intraperitoneal | 34/127 (26.8%) | 20/52 (38.5%) | 14/75 (18.7%) | 0.013 | 2.723 (1.216–6.096) | 0.014 | |||
| Altemeier class 1 | 110/128 (85.9%) | 44/52 (84.6%) | 66/76 (86.8%) | 0.722 | 0.833 (0.305–2.276) | 0.722 | |||
| Infection presentation | |||||||||
| Time from surgery to onset of symptoms (days) | 14 (8–26) | 13 (7–50) | 14 (8-23.3) | 0.801 | 1.000 (0.999-1.000) | 0.533 | |||
| Highest CRP level (mg/L) | 130 (60–205) | 142 (60–250) | 124.5 (0-180.8) | 0.234 | 1.002 (0.998–1.005) | 0.213 | |||
| Infection type | |||||||||
| Inflammatory wound dehiscence | 9/131 (6.9%) | 0/54 (0%) | 9/77 (11.7%) | 0.009 | NC | NC | |||
| Abscess | 120/131 (91.6%) | 53/54 (98.1%) | 67/77 (87.0%) | 0.026 | 7.910 (0.981–63.761) | 0.052 | |||
| Abdominal wall abscess | 114/131 (87.0%) | 49/54 (90.7%) | 65/77 (84.4%) | 0.289 | 1.809 (0.597–5.474) | 0.293 | |||
| Deep abscess | 13/131 (9.9%) | 7/54 (13.0%) | 6/77 (7.8%) | 0.330 | 1.762 (0.557–5.571) | 0.334 | |||
| Sinus tract | 73/131 (55.7%) | 36/54 (66.7%) | 37/77 (48.1%) | 0.035 | 2.162 (1.051–4.446) | 0.036 | |||
| Enterocutaneous sinus tract | 6/131 (4.6%) | 4/54 (7.4%) | 2/77 (2.6%) | 0.229 | 2.999 (0.529–17.001) | 0.214 | |||
| Early post-operative peritonitis | 0/131 (0%) | 0/54 (0%) | 0/77 (0%) | NC | NC | NC | |||
| Microbiology results | 94/131 (71.8%) | 43/54 (79.6%) | 51/77 (66.2%) | 0.094 | 1.992 (0.883–4.495) | 0.096 | |||
| Sterile | 6/94 (6.4%) | 3/43 (7.0%) | 3/51 (5.9%) | 1.000 | 1.199 (0.229–6.275) | 0.828 | |||
| Polymicrobial | 47/94 (50.0%) | 24/43 (55.8%) | 23/51 (45.1%) | 0.301 | 1.537 (0.679–3.478) | 0.301 | |||
| S.aureus | 36/94 (38.3%) | 14/43 (32.6%) | 22/51 (43.1%) | 0.293 | 0.636 (0.273–1.481) | 0.294 | |||
| CoNS | 6/94 (6.4%) | 3/43 (7.0%) | 3/51 (5.9%) | 1.000 | 1.199 (0.229–6.275) | 0.828 | |||
| Streptococcus spp. | 8/94 (8.5%) | 4/43 (9.3%) | 4/51 (7.8%) | 1.000 | 1.205 (0.282–5.134) | 0.800 | |||
| Enterococcus spp. | 16/94 (17.0%) | 6/43 (14.0%) | 10/51 (19.6%) | 0.467 | 0.664 (0.220–2.008) | 0.469 | |||
| Corynebacterium spp. | 3/94 (3.2%) | 2/43 (4.7%) | 1/51 (2.0%) | 0.591 | 2.439 (0.213–27.863) | 0.473 | |||
| Cutibacterium spp. | 2/94 (2.1%) | 2/43 (4.7%) | 0/51 (0%) | 0.207 | NC | NC | |||
| Enterobacteriaceae | 29/94 (30.9%) | 14/43 (32.6%) | 15/51 (29.4%) | 0.742 | 1.158 (0.481–2.785) | 0.742 | |||
| Pseudomonas spp. | 5/94 (5.3%) | 2/43 (4.7%) | 3/51 (5.9%) | 1.000 | 0.780 (0.124-4.900) | 0.791 | |||
| Anaerobes | 22/94 (23.4%) | 11/43 (25.6%) | 11/51 (21.6%) | 0.647 | 1.249 (0.480–3.252) | 0.647 | |||
| Actinomyces spp. | 4/94 (4.3%) | 2/43 (4.7%) | 2/51 (3.9%) | 1.000 | 1.195 (0.161–8.860) | 0.861 | |||
| Fungi | 3/94 (3.2%) | 3/43 (7.0%) | 0/51 (0%) | 0.092 | NC | NC | |||
| Infection management | |||||||||
| Local treatment only | 45/131 (34.4%) | 22/54 (40.7%) | 23/77 (29.9%) | 0.197 | 1.614 (0.777–3.349) | 0.198 | |||
| Radiological drainage | 18/131 (13.7%) | 6/54 (11.1%) | 12/77 (15.6%) | 0.608 | 0.677 (0.237–1.932) | 0.466 | |||
| Surgery | 41/131 (31.3%) | 17/54 (31.5%) | 24/77 (31.2%) | 0.970 | 1.014 (0.479–2.147) | 0.969 | |||
| Partial mesh removal | 11/131 (8.4%) | 3/54 (5.6%) | 8/77 (10.4%) | 0.524 | 0.507 (0.128–2.007) | 0.333 | |||
| Single-stage abdominal wall reconstruction | 0/51 (0%) | 0/20 (0%) | 0/31 (0%) | NC | NC | NC | |||
| Negative pressure therapy alone | 4/131 (3.1%) | 1/54 (1.9%) | 3/77 (3.9%) | 0.643 | 0.465 (0.047–4.598) | 0.512 | |||
| Post-operative negative pressure therapy | 29/131 (22.1%) | 8/54 (14.8%) | 21/77 (27.3%) | 0.134 | 0.463 (0.188–1.143) | 0.095 | |||
| Antibiotic treatment | 112/130 (86.2%) | 42/53 (79.2%) | 70/77 (90.9%) | 0.058 | 0.381 (0.137–1.060) | 0.064 | |||
| Adapted empiric antibiotic therapy | 58/75 (77.3%) | 22/29 (75.9%) | 36/46 (78.3%) | 0.809 | 0.873 (0.290–2.627) | 0.809 | |||
| Secondary adaptation | 41/68 (60.3%) | 13/25 (52.0%) | 28/43 (65.1%) | 0.286 | 0.580 (0.212–1.584) | 0.288 | |||
| Treatment duration (days) | 14 (9–21) | 11 (7–19) | 14 (0–21) | 0.086 | 0.996 (0.972–1.021) | 0.782 | |||
| Outcomes | |||||||||
| Failure | 54/131 (41.2%) | 54/54 (100%) | NA | NA | NA | NA | |||
| Time to failure (days) | 36.5 (16–183) | 36.5 (16–183) | NA | NA | NA | NA | |||
| Hernia recurrence | 32/131 (24.4%) | 16/54 (29.6%) | 16/77 (20.8%) | 0.246 | 1.605 (0.719–3.582) | 0.247 | |||
| Subsequent surgery for infectious purpose | 42/131 (32.1%) | 42/54 (77.8%) | NA | NA | NA | NA | |||
| Follow-up time (weeks) | 76 (25.9-201.1) | 73.2 (32.3-180.3) | 77.9 (26-203.3) | 0.861 | 1.000 (0.997–1.002) | 0.846 | |||
95%CI, 95% confidence interval; ASA, American Society of Anesthesiologists, BMI, Body mass index; CoNS, Coagulase negative staphylococci; CRP, C-reactive protein; NA, Not applicable; NC, Not calculable; OR, Odd ratio