Postoperative Surgical Site Infection after Incisional Hernia Repair: Link to Previous Surgical Site Infection?

Abstract

Objective: Aim of the study was to determine the affects of different factors in general and previous surgical site infection (SSI) in particular, on postoperative SSI in patients undergoing open ventral Incisional hernia repair in a clean setting as there is still a lot of controversy on this issue. Patients & Methods: This is a Prospective study conducted at Madina Teaching Hospital, University Medical & Dental College, Faisalabad from January 2006 to September 2010. All patients undergoing open ventral Incisional hernia repair in a clean setting were evaluated for a postoperative surgical site infection (SSI).  The development of a postoperative surgical site infection was taken as the primary endpoint. Patients were divided into two groups, without history of postoperative SSI and with history of postoperative SSI. Both groups were compared regarding demographic factors, Perioperative data and development of postoperative SSI. Results: 167 patients met the predefined criteria and were analyzed. Of these, 25patients were having prior wound infection after their previous surgery. Univariate analysis was done. It showed that patients with prior wound infection and those without prior wound infection had similar characteristics (Table 1). American Society of Anesthesiology (ASA) score (3.1 vs. 3.7; P .003) and percentage of smokers (3.1 vs. 3.7; P .003) was found to be significantly lower in the group with no history of wound infection as compared to other group with history of wound infection. There was no significant difference between two groups regarding use of permanent synthetic mesh (78% vs. 76%; P .571), requirement for an anterior component separation (18% vs. 07%; P .138), surgical site infection within 30 days after surgery (11% vs. 16%; P .487). The patients requiring surgical debridement after a postoperative SSI were similar in the two groups (31% vs. 25%; P .793) (Table 2). History of previous wound infection was not a significant factor, when we evaluated for predictors of surgical site infection after ventral hernia repair (odds ratio [OR], 1.47; P .436). However, a history of chronic obstructive airway disease (COAD) (OR, 4.09; P .018) and a history of smoking (OR, 6.01; P .004) were found to be significant predictors for an increased risk of developing a surgical site infection after ventral hernia repair in this group of patients (Table 3). Conclusions: We were unable to demonstrate any link between a previous SSI and a higher rate of SSI after open ventral hernia repair. Chronic obstructive airway disease & Smoking were identified as primary risk factors predictive of a postoperative surgical site infection.