P34 – Surgical Site Infection in Ventral Hernia Patients with Open Incisional Hernia Repair

Author(s):
Yen Hong Kuo, Yen-Liang Kuo, Nasim Ahmed, John Davis, Jersey Shore University Medical Center affiliate of RWJ Medical School

Background: The purpose of this study was to evaluate the rate of surgical site infection in patients undergoing open incisional hernia repair.

Hypothesis: Patient characteristics contribute to surgical site infection

Methods: A retrospective cohort study was conducted by using the 2006 Nationwide Inpatient Sample to evaluate adult patients with ventral hernias. The disease status and procedures were categorized according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).
Patients with a primary diagnosis of hernia with or without obstruction, with procedure of incisional hernia repair with graft or prosthesis were included for this study. The primary measured outcome for the study was surgical site infection as defined by a patient who had record of cellulitis or abscess, peritoneal abscess, infection postoperative seroma (ICD-9 code 998.51), or other postoperative infection.
The weighted number of procedures and rates were calculated to take into consideration the stratified sampling design of NIS data.

Results: An estimated 47,007 procedures were performed in U.S. in 2006; 50.5% of the patients had hypertension, 20.2% were obese, 19.3% had chronic pulmonary disease, 18.6% had diabetes, and 6.5% had fluid and electrolyte disorders. Postoperatively 1.1% had a surgical site infection (SSI). Age and gender did not differ in those who did and did not who did not experience SSI (mean [standard error]: SSI vs. no SSI = 58.7 [1.34] vs. 58.2 [0.22] years, P=0.89 and female %: SSI vs. no SSI= 63.7% vs. 64.7%, P=0.84). However, a higher proportion of patients had fluid and electrolyte disorders (SSI vs. no SSI =19.1% vs. 6.4%, P<0.0001). From a multiple logistic regression model, patients with fluid and electrolyte disorders had an increased chance of experiencing SSI (adjusted odds ratio {AOR} [95% confidence interval {CI}] = 3.29 [2.03, 5.34], P<0.0001). Chronic pulmonary disease also associated with an increased chance (AOR[95% CI]=1.54 [1.03, 2.30], P=0.03). However, obesity did not show a significant association with SSI (AOR[95% CI]= 1.12[0.72, 1.73], P=0.63).

Conclusions: The SSI rate reported was low compared to current publications not using the NIS database. Patients with fluid and electrolyte disorders or chronic pulmonary disease had a higher chance of experiencing surgical site infection.