Incidence of autoimmune disease after hernia surgery with a mesh implant: national retrospective cohort study

BACKGROUND: Some patients report experiencing various systemic symptoms after surgical placement of a (polypropylene (PP)) mesh implant, including fatigue, arthritis, and myalgia. As these complaints could resemble systemic symptoms of autoimmune disease (AID), there are concerns that mesh implants could induce such disorders. The aim of this study was to identify the incidence of AID after mesh implantation, compared with controls in whom no mesh was implanted. METHODS: In this national retrospective cohort study, approximately 4 million people insured with Dutch health insurer Coöperatie VGZ were screened for operative procedure reimbursements for inguinal and incisional hernia repair, between January 2015 and January 2019. Patients who underwent cholecystectomy were included as controls, as no mesh is implanted during this procedure. Patients were followed from 2 years before surgery to 3 years after surgery. The primary outcome was the difference in the incidence of AID after mesh implantation, compared with surgery without mesh. Propensity score matching for age, sex, and socioeconomic status was performed to reduce selection bias. RESULTS: The cohort included 19 464 inguinal/incisional hernia patients (86.0% male) and 18 259 cholecystectomy patients (31.8% male). After matching, both groups consisted of 1500 patients. The incidence of new AID during follow-up was not statistically different between the two groups (1.1% for the intervention group and 1.5% for the control group; P = 0.520). CONCLUSION: Based on this cohort study, mesh implants do not increase the medium-term risk of developing AID.