Ramos RD, O’Brien WJ, Gupta K, et al. - The long-term incidence and risk factors for synthetic mesh explantation due to infection after hernia surgery were investigated in a large cohort. They performed retrospective database study using Veterans Affairs Surgical Quality Improvement Program (VASQIP) and chart review of veterans undergoing abdominal or groin hernia repair with synthetic mesh implantation. A total of 103,869 hernia operations were conducted in the study population; of these, 74.3% were inguinal, 10.7% umbilical, and 15.0% ventral. Explantation incidence for infection was highest after ventral hernia repair. Multivariable logistic regression revealed higher explantation risk in correlation with all obesity levels from pre-obesity to obesity class III. American Society of Anesthesiology (ASA) Classification of 3-5 was linked with 1.7 odds ratio, as was longer operative duration, and contaminated or dirty surgical wound classification. Relative to inguinal repair, umbilical repair and ventral repair were linked with higher risk. A higher risk was observed in correlation with open vs laparoscopic repair. Likelihood of long-term mesh explantation was higher in correlation with deep incisional surgical site infection (29.2%) within 30 days of surgery vs either superficial (6.4%) or organ space infection (22.4%). Based on findings, they emphasize risk factor optimization to lower such an outcome.