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BACKGROUND: We investigate the effect of antiplatelet and anticoagulant medications on bleeding complications in patients undergoing ventral hernia repair. METHODS: The Abdominal Core Health Quality Collaborative registry was queried from 2013 to 2022 for patients who underwent ventral hernia repair, evaluating the association between antiplatelet or anticoagulant use and bleeding complications. RESULTS: 37,973 patients underwent ventral hernia repair: 11.5 â% on antiplatelet therapy alone and 5.8 â% on anticoagulation alone. Despite being held, an adjusted regression analysis showed that anticoagulation was associated with an increased risk for postoperative bleeding requiring transfusion (OR 2.4 [1.7-3.4], p â< â0.0001), reoperation for postoperative bleeding (OR 6.3 [3.9-10.0], p â< â0.0001), and readmission for bleeding complications (OR 4.9 [2.9-8.2], p â< â0.0001). Antiplatelet use was not a risk factor for any postoperative bleeding complication. CONCLUSION: Despite being held preoperatively, patients on anticoagulants are at an increased risk for postoperative hemorrhagic complications. Antiplatelet therapy does not pose the same risk.
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INTRODUCTION: Managing acute postoperative pain in patients on chronic opioid therapy is challenging. There is little data regarding optimal perioperative chronic opioid management. We hypothesized that continuing the home dose of opioid while inpatient following ventral hernia repair (VHR) would reduce total opioid consumption postoperatively. METHODS: Chronic opioid users were ordered their home opioid scheduled and our standard multimodal analgesia regimen. At time of discharge, we reviewed inpatient opioid use and prescribed opioids based on morphine milligram equivalent (MME) consumed per our established protocol. RESULTS: VHR was performed in 658 patients with 117 utilizing chronic opioid medications from June 2017 through March 2022; 43 patients were managed on protocol and 74 were not. Inpatient daily MME consumption was similar between groups (34 vs 36 MME; p â= â0.285). Patients treated according to protocol received significantly lower MME prescriptions at discharge (80 vs 225 MME; p â< â0.001) with similar refills (21.4 vs 25.4 â%; p â= â0.820). CONCLUSION: Continuing home opioids for chronic opioid users following VHR resulted in less opioid prescribing with no increase in refills.
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BACKGROUND: The clinical and financial impact of surgical site infection after ventral hernia repair is significant. Here we investigate the impact of dual antibiotic irrigation on SSI after VHR. METHODS: This was a multicenter, prospective randomized control trial of open retromuscular VHR with mesh. Patients were randomized to gentamicin â+ âclindamycin (G â+ âC) (n â= â125) vs saline (n â= â125) irrigation at time of mesh placement. Primary outcome was 30-day SSI. RESULTS: No significant difference was seen in SSI between control and antibiotic irrigation (9.91 vs 9.09 â%; p â= â0.836). No differences were seen in secondary outcomes: SSO (11.71 vs 13.64 â%; p â= â0.667); 90-day SSO (11.1 vs 13.9 â%; p â= â0.603); 90-day SSI (6.9 vs 3.8 â%; p â= â0.389); SSIPI (7.21 vs 7.27 â%, p â= â0.985); SSOPI (3.6 vs 3.64 â%; p â= â0.990); 30-day readmission (9.91 vs 6.36 â%; p â= â0.335); reoperation (5.41 vs 0.91 â%; p â= â0.056). CONCLUSION: Dual antibiotic irrigation with G â+ âC did not reduce the risk of surgical site infection during open retromuscular ventral hernia repair.