8. Unveiling The Role of Mesh in Postoperative Pain Following Abdominal Wall Reconstruction: A Propensity-score Match Analysis

PURPOSE: This study aims to assess the impact of mesh implantation on the development of acute and chronic postoperative pain in patients undergoing ventral hernia repair (VHR). METHODS: A multicenter retrospective analysis was conducted using TriNetX to identify patients who underwent VHR. Patients were divided into two cohorts: those with concurrent mesh implantation (either synthetic or biological) and those without mesh. One-to-one nearest-neighbor propensity score matching was performed to adjust for baseline differences. The primary outcome was the incidence of postoperative pain at multiple time points. Group differences were analyzed using t-tests, chi-square tests, and logistic regression models. RESULTS: After propensity score matching, 53,712 patients remained, evenly divided between the mesh and non-mesh cohorts. Patients with mesh implantation had similar odds of developing chronic postoperative pain at 6 months (OR 1.09; 95%CI0.96-1.25;p=0.19) and 1 year (OR 1.14; 95%CI 1.03-1.26;p=0.009). However, after two years, the odds of chronic pain became significantly higher in the mesh group (OR 1.21; 95%CI1.21;p<0.001), with this risk continuing to rise over time, up to 5 years postoperatively (OR 1.22; 95%CI1.22;p<0.001). Additionally, patients with mesh had higher rates of 90-day wound complications (8.8% vs.6.0%;p<0.001), emergency department visits (6.0% vs. 4.7%;p<0.001), and hospitalizations (9.9% vs. 7.4%;p<0.001). CONCLUSION: Mesh implantation in VHR appears to be associated with a significantly increased risk of chronic postoperative pain beginning at two years postoperatively, with this risk continuing to rise over time.