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The Impact of Conflict of Interest in Abdominal Wall Reconstruction With Acellular Dermal Matrix

DeGeorge, Brent R. Jr MD, PhD; Holland, Michael C. BS; Drake, David B. MD

doi: 10.1097/SAP.0000000000000372

Introduction Conflict of interest (COI) and disclosure of financial relationships have received increased attention recently owing in part to the passage of the Physician Payments Sunshine Act, which requires manufacturers of drugs, medical devices, and biological to record payments to physicians and health care systems. The impact of financial relationships with industry sponsorship and COI reporting on surgical outcomes of abdominal wall reconstruction with acellular dermal matrices (ADMs) has not been previously explored.

Methods A systematic review of the literature for studies that evaluated surgical outcomes in abdominal wall reconstruction using ADM was conducted. The level of evidence of these studies was evaluated; and data concerning the type of industry, government, or national society sponsorship, primary outcome, complications, and statistical results were collected. The overall favorability of the study with respect to ADM use was systematically assessed. Comparisons between type of sponsorship and significant results were analyzed using the Pearson χ2 test.

Results A total of 204 studies were identified, of which 124 fulfilled our inclusion criteria. Sixty-four (52%) studies had a disclosure statement present. Conflict of interest was reported in 39 (61%) of these studies. Taken collectively, studies that report no COI are more likely to be unfunded (P < 0.001). Studies with a reported COI are more likely to report a favorable outcome with respect to infection (P < 0.01), wound complications (P < 0.01), and overall morbidity (P < 0.07) and mortality (P < 0.05).

Conclusions Industry sponsorship and COI are common in abdominal wall reconstruction studies with ADM. Studies authored by groups disclosing an industry conflict that report clinical outcomes are significantly associated with reporting lower postoperative complications, and consequently describing positive research findings.

From the Department of Plastic Surgery, University of Virginia Medical Center, Charlottesville, VA.

Received August 7, 2014, and accepted for publication, after revision, September 23, 2014.

Conflicts of interest and sources of funding: none declared.

Reprints: David B. Drake, MD, Department of Plastic Surgery, University of Virginia Medical Center, PO Box 800376, Charlottesville, Virginia, 22908, USA. E-mail:

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