2013 myresearch Public Health Internship Program

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3 2013 myresearch Public Health Internship Program

4 Joo Kim Public Health Internship Program

5 Open Repair: Significance of Mesh Type on Inguinal Herniorrhaphy Joo Kim Richard T. Guttman Jr., MD, FACS

6 Abstract An inguinal hernia occurs when intra-abdominal contents protrude through an opening or defect in the inguinal fascia. Two Approaches for Herniorrhaphies: Open and Laparoscopic Most Commonly used Mesh types: Bard, Ethicon, and Covidien

7 Background Inguinal hernia repair is the most common surgery. Inguinal hernia repair accounts for approximately 800,000 cases yearly. Likelihood in each gender: Male: 27% Female: 3%

8 Purpose What is the influence of mesh type on inguinal herniorrhaphy patients?

9 Hypothesis The Cleveland Clinic standardization to Covidien mesh should affect patient outcomes with decreased complication rates.

10 Methodology A de-identified, retrospective study focusing on pre-, intra- and post-operation factors was conducted to determine the impact of the open repair meshes. Types of Mesh: Bard, Covidien, and Ethicon Data points will be found on Operative notes, Nurse notes, and Surgery notes from the Epic system.

11 Distribution of Mesh Type Number of Patients n=305 Use of Each Mesh Type Before and After Standardization Ethicon, 134, 43.9% Covidien, 118, 38.7% After Covidien Ethicon 1 Bard Before Bard, 53, 17.4%

12 Co-Morbidities: Smoking Status and Diabetes Smoking Smoking Smoking Type of Diabetes: Diabetes: Diabetes: Status: Status: Status: Mesh: Yes No Unknown Yes No EX 4, 24, 18, Bard 1, 44, 8, 7.5% 45.3% 34.0% 1.9% 83.0% 15.1% 10, 65, 57, Ethicon 9, 121, 4, 7.5% 48.5% 42.5% 6.7% 90.3% 3.0% 22, 51, 43, Covidien 8, 105, 5, 18.6% 43.2% 36.4% 6.8% 89.0% 4.2%

13 Co-Morbidities: Pulmonary Issues and BMI Pulm. Pulm. Pulm. Pulm. Type of Obese: Obese: Issues: Issues: Issues: Issues: Mesh Yes No No COPD Asthma Other 42, 1, 1, 2, Bard 12, 34, 79.3% 1.9% 1.9% 3.8% 22.6% 64.2% 119, 5, 5, 5, Ethicon 18, 116, 88.8% 3.7% 3.7% 3.7% 13.4% 86.6% 100, 2, 11, 5, Covidien 22, 96, 84.7% 1.7% 9.3% 4.2% 18.6% 81.4%

14 Post-Operation Complications Covidien: Before Ethicon: Before Bard: Before ASA: 1 ASA: 2 ASA: 3 ASA: ASA: 1 ASA: 2 ASA: 3 ASA: Unknown Covidien: After Ethicon: After Bard: After

15 Post-Operation Complications Covidien: Before Ethicon: Before Bard: Before Complaints: Yes Complaints: No Covidien: After Ethicon: After Bard: After 20 0 Complaints: Yes Complaints: No

16 Post Operation Complications Covidien: Before Ethicon: Before Bard: Before 20 0 Refill: 0 to 1 Refill: 2+ VAS: 0 to 3 VAS: 4 to 6 VAS: Covidien: After Ethicon: After Bard: After 50 0 Refills: 0 to 1 Refills: 2+ VAS: 0 to 3 VAS: 4 to 6 VAS: 7+

17 Results Bard: 46 Most complaints and 2+ refills After and sickest population. Ethicon: 134 Most complaints in Before. Covidien: 118 Highest % of 0 to 1 refills After and healthiest population.

18 Conclusions Our populations were relatively similar with: Bard portion of the population with the highest ASA 3 rate Covidien had the healthiest population Ethicon had the highest 2+ refill rate before Bard had the highest rate of 7+ VAS scores before Bard had the highest percentage of post operative complaints

19 Recommendations Use a larger population for the study: More expansive time span Find more specific trends: Different facilities Different surgeons Different techniques

20 References 3DMAX Mesh - Davol. (n.d.). Bard. Retrieved June 28, 2013, from Asa physical status classification system. (n.d.). Retrieved from Physical-Status-Classification-System Inguinal Hernia. (n.d.). Mayo Clinic. Retrieved June 30, 2013, from Li, J. (2012). Lightweight versus heavyweight in inguinal hernia repair: A meta-analysis. 16(5), Retrieved from Parietex ProGrip Self Fixating Mesh. (n.d.). Covidien. Retrieved July 1, 2013, from

21 Special Thanks Richard T. Guttman Jr., MD, FACS The Office of Civic Education Initiatives Rosalind Strickland, Senior Director, Office of Civic Education Initiatives Nedra Starling, MPH, ABD, Manager, Instructional Design, Office of Civic Education Initiatives

22 Copyright 2013 Cleveland Clinic Foundation

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