to reduce the infection rate, chronic inflammation and foreign body
reaction associated with the use of prosthetic mesh for complex
abdominal wall hernia repair.
But first the administrator wanted proof, compelling clinical evi-
dence that biologic mesh would improve the outcomes of her sur-
geons' abdominal wall reconstructive surgeries enough to justify the
added case costs. So she commissioned the ECRI Institute to conduct
an independent review and objective study that paralleled the model
of Consumer Reports.
' They're equivalent '
After an expansive review of the last 5 years of mesh literature —
57 references in all, including systematic reviews, cost-effective
analyses and randomized control trials — ECRI returned its ver-
dict: They're equivalent. There are no data to say that synthetic or
biologic is superior to the other in terms of minimizing recurrence
rates and complications like painful adhesions and wound infec-
tions.
"All the data point to equivalence," says David Snyder, PhD, senior
research analyst in ECRI Institute's Health Technology Assessment
group. "There's nothing wrong with either product. It's just that the
clinical evidence says they're equivalent."
ECRI Institute's search of the literature found recommendations that
you reserve biologic mesh for contaminated or infected surgical fields
— patients with a previous infection (abdominal wall or mesh), active
infection or intraoperative contamination — or in revision surgery
(most likely due to an infection).
Dr. Snyder points to a clinical practice guideline from the European
Hernia Society that recommends that further studies are needed to
determine the cost-effectiveness of biologic mesh. One cost analysis
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