Intra-Abdominal Placement of Antimicrobial-Impregnated Mesh is Associated with Noninfectious Fever

Abstract

The antimicrobial, silver/chlorhexidine, when impregnated on mesh has been demonstrated to resist mesh infection in in vitro and in vivo models. The clinical, human systemic response to intraperitoneal placement of silver/chlorhexidine-impregnated mesh has not been investigated to date. Between October 2002 and November 2004, all in-patients undergoing laparoscopic ventral hernia repair were retrospectively analyzed. All repairs used expanded polytetraflouroethylene (ePTFE) Dual Mesh (DM) or ePTFE impregnated with silver/chlorhexidine, Dual Mesh Plus (DM+). Patient demographics, hernia characteristics, mesh type, operative details, and hospital course data were collected. Noninfectious fevers were defined as a temperature greater than 100.4 F without an identified source. Standard statistical methods were used. During the 2-year study period, 120 patients underwent laparoscopic ventral hernia repair (DM = 55, DM+ = 65). The two groups were similarly matched in terms of age, body mass index, American Society of Anesthesiologists score, defect size, and mesh size. Postoperative fever without an identified source occurred in 10 (18.2%) patients with DM and in 25 (38.5%) patients using DM+ (P = 0.015). A multivariant analysis revealed that only mesh type and body mass index predicted postoperative fever. All fevers resolved within the first 72 hours in the DM patients; however, 16 per cent of the DM+ group had persistent fevers of unknown origin after 72 hours. Within the DM+ group, patients with postoperative fevers had significantly longer postoperative stays (4.8 days vs 3.0 days; P = 0.009). The use of antimicrobial-impregnated ePTFE mesh with silver/chlorhexidine in laparoscopic ventral hernia repair is associated with noninfectious postoperative fever. In our patients, the evaluation and management of these fevers resulted in a significantly longer hospital stay.