Obstructing ventral hernias are not independently associated with surgical site infections

Megan Sippey, Anthony B. Mozer, Marysia Grzybowski, Mark L. Manwaring, Kevin R. Kasten, Gina L. Adrales, Walter E. Pofahl, Konstantinos Spaniolas

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Delayed operative intervention in the setting of adhesive bowel obstruction has been recently shown to increase the rate of surgical site infection (SSI), raising the concern for bacterial translocation. The effect of obstruction on SSI rate in patients with ventral hernia is unknown. The aim of this study was to assess the association between bowel obstruction and SSI in patients undergoing ventral hernia repair (VHR).

MATERIALS AND METHODS: This study is a retrospective database review. Patients undergoing isolated VHR from 2005-2011 were identified from the American College of Surgeons' National Surgical Quality Improvement Program database. Demographics, comorbidities, and 30-d outcomes were analyzed. Multivariate logistic regression was used for variables with a P value of <0.1.

RESULTS: A total of 68,811 patients underwent isolated VHR; 53.1% were male with mean age of 53 ± 15 y and body mass index of 32 ± 8. Hernia-related obstruction was found in 17,058 (24.8%). In patients with obstruction, SSI was more frequent (3.2% versus 2.6%, P < 0.001). Obesity, advanced age, vascular, pulmonary, hepatic, renal disease, and diabetes were more prevalent. After controlling for confounding baseline variables, bowel obstruction was not independently associated with SSI (odds ratio, 0.983, 95% confidence interval, 0.872-1.107). Subgroup analysis of clean classified cases also demonstrated the lack of independent association between obstruction and SSI.

CONCLUSIONS: Obstruction in patients undergoing VHR is not independently associated with SSI. Our results suggest that mesh implantation remains a viable option in this setting. Other confounding comorbid conditions should be assessed at the time of surgical intervention to identify patients appropriate for mesh repair.

LanguageEnglish (US)
Pages326-330
Number of pages5
JournalThe Journal of surgical research
Volume199
Issue number2
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

Fingerprint

Ventral Hernia
Surgical Wound Infection
Herniorrhaphy
Databases
Bacterial Translocation
Confounding Factors (Epidemiology)
Hernia
Quality Improvement
Adhesives
Blood Vessels
Comorbidity
Body Mass Index
Obesity
Logistic Models
Odds Ratio
Demography
Confidence Intervals
Kidney
Lung
Liver

Keywords

  • Obstruction
  • Surgical site infection
  • Ventral hernia repair

ASJC Scopus subject areas

  • Surgery

Cite this

Sippey, M., Mozer, A. B., Grzybowski, M., Manwaring, M. L., Kasten, K. R., Adrales, G. L., ... Spaniolas, K. (2015). Obstructing ventral hernias are not independently associated with surgical site infections. The Journal of surgical research, 199(2), 326-330. DOI: 10.1016/j.jss.2015.04.079

Obstructing ventral hernias are not independently associated with surgical site infections. / Sippey, Megan; Mozer, Anthony B.; Grzybowski, Marysia; Manwaring, Mark L.; Kasten, Kevin R.; Adrales, Gina L.; Pofahl, Walter E.; Spaniolas, Konstantinos.

In: The Journal of surgical research, Vol. 199, No. 2, 01.12.2015, p. 326-330.

Research output: Contribution to journalArticle

Sippey, M, Mozer, AB, Grzybowski, M, Manwaring, ML, Kasten, KR, Adrales, GL, Pofahl, WE & Spaniolas, K 2015, 'Obstructing ventral hernias are not independently associated with surgical site infections' The Journal of surgical research, vol 199, no. 2, pp. 326-330. DOI: 10.1016/j.jss.2015.04.079
Sippey M, Mozer AB, Grzybowski M, Manwaring ML, Kasten KR, Adrales GL et al. Obstructing ventral hernias are not independently associated with surgical site infections. The Journal of surgical research. 2015 Dec 1;199(2):326-330. Available from, DOI: 10.1016/j.jss.2015.04.079
Sippey, Megan ; Mozer, Anthony B. ; Grzybowski, Marysia ; Manwaring, Mark L. ; Kasten, Kevin R. ; Adrales, Gina L. ; Pofahl, Walter E. ; Spaniolas, Konstantinos. / Obstructing ventral hernias are not independently associated with surgical site infections. In: The Journal of surgical research. 2015 ; Vol. 199, No. 2. pp. 326-330
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abstract = "BACKGROUND: Delayed operative intervention in the setting of adhesive bowel obstruction has been recently shown to increase the rate of surgical site infection (SSI), raising the concern for bacterial translocation. The effect of obstruction on SSI rate in patients with ventral hernia is unknown. The aim of this study was to assess the association between bowel obstruction and SSI in patients undergoing ventral hernia repair (VHR).MATERIALS AND METHODS: This study is a retrospective database review. Patients undergoing isolated VHR from 2005-2011 were identified from the American College of Surgeons' National Surgical Quality Improvement Program database. Demographics, comorbidities, and 30-d outcomes were analyzed. Multivariate logistic regression was used for variables with a P value of <0.1.RESULTS: A total of 68,811 patients underwent isolated VHR; 53.1{\%} were male with mean age of 53 ± 15 y and body mass index of 32 ± 8. Hernia-related obstruction was found in 17,058 (24.8{\%}). In patients with obstruction, SSI was more frequent (3.2{\%} versus 2.6{\%}, P < 0.001). Obesity, advanced age, vascular, pulmonary, hepatic, renal disease, and diabetes were more prevalent. After controlling for confounding baseline variables, bowel obstruction was not independently associated with SSI (odds ratio, 0.983, 95{\%} confidence interval, 0.872-1.107). Subgroup analysis of clean classified cases also demonstrated the lack of independent association between obstruction and SSI.CONCLUSIONS: Obstruction in patients undergoing VHR is not independently associated with SSI. Our results suggest that mesh implantation remains a viable option in this setting. Other confounding comorbid conditions should be assessed at the time of surgical intervention to identify patients appropriate for mesh repair.",
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N2 - BACKGROUND: Delayed operative intervention in the setting of adhesive bowel obstruction has been recently shown to increase the rate of surgical site infection (SSI), raising the concern for bacterial translocation. The effect of obstruction on SSI rate in patients with ventral hernia is unknown. The aim of this study was to assess the association between bowel obstruction and SSI in patients undergoing ventral hernia repair (VHR).MATERIALS AND METHODS: This study is a retrospective database review. Patients undergoing isolated VHR from 2005-2011 were identified from the American College of Surgeons' National Surgical Quality Improvement Program database. Demographics, comorbidities, and 30-d outcomes were analyzed. Multivariate logistic regression was used for variables with a P value of <0.1.RESULTS: A total of 68,811 patients underwent isolated VHR; 53.1% were male with mean age of 53 ± 15 y and body mass index of 32 ± 8. Hernia-related obstruction was found in 17,058 (24.8%). In patients with obstruction, SSI was more frequent (3.2% versus 2.6%, P < 0.001). Obesity, advanced age, vascular, pulmonary, hepatic, renal disease, and diabetes were more prevalent. After controlling for confounding baseline variables, bowel obstruction was not independently associated with SSI (odds ratio, 0.983, 95% confidence interval, 0.872-1.107). Subgroup analysis of clean classified cases also demonstrated the lack of independent association between obstruction and SSI.CONCLUSIONS: Obstruction in patients undergoing VHR is not independently associated with SSI. Our results suggest that mesh implantation remains a viable option in this setting. Other confounding comorbid conditions should be assessed at the time of surgical intervention to identify patients appropriate for mesh repair.

AB - BACKGROUND: Delayed operative intervention in the setting of adhesive bowel obstruction has been recently shown to increase the rate of surgical site infection (SSI), raising the concern for bacterial translocation. The effect of obstruction on SSI rate in patients with ventral hernia is unknown. The aim of this study was to assess the association between bowel obstruction and SSI in patients undergoing ventral hernia repair (VHR).MATERIALS AND METHODS: This study is a retrospective database review. Patients undergoing isolated VHR from 2005-2011 were identified from the American College of Surgeons' National Surgical Quality Improvement Program database. Demographics, comorbidities, and 30-d outcomes were analyzed. Multivariate logistic regression was used for variables with a P value of <0.1.RESULTS: A total of 68,811 patients underwent isolated VHR; 53.1% were male with mean age of 53 ± 15 y and body mass index of 32 ± 8. Hernia-related obstruction was found in 17,058 (24.8%). In patients with obstruction, SSI was more frequent (3.2% versus 2.6%, P < 0.001). Obesity, advanced age, vascular, pulmonary, hepatic, renal disease, and diabetes were more prevalent. After controlling for confounding baseline variables, bowel obstruction was not independently associated with SSI (odds ratio, 0.983, 95% confidence interval, 0.872-1.107). Subgroup analysis of clean classified cases also demonstrated the lack of independent association between obstruction and SSI.CONCLUSIONS: Obstruction in patients undergoing VHR is not independently associated with SSI. Our results suggest that mesh implantation remains a viable option in this setting. Other confounding comorbid conditions should be assessed at the time of surgical intervention to identify patients appropriate for mesh repair.

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