A call for standardization of wound events reporting following ventral hernia repair

Haskins, Ivy N.; Horne, Charlotte; Krpata, David M.; Prabhu, Ajita S.; Tastaldi, Luciano; Perez, Arielle J.; Rosenblatt, Steven; Poulose, B. K.; Rosen, Michael J.

doi:10.1007/s10029-018-1748-6

Cited by 114 publications

(46 citation statements)

References 26 publications

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“…The definition of SSO, according to the Ventral Hernia Working Group, includes surgical site infection (SSI), seroma, hematoma, skin or soft tissue necrosis, nonhealing incisional wound, infected or exposed mesh, and FD. 30,43,44 SSI was defined according to CDC criteria, limited to the follow-up time of this study. 45 Organ/space SSI (intraabdominal complications) was not considered an SSO.…”

Section: Fdmentioning

confidence: 99%

“…Surgical site occurrence requiring procedural intervention was defined as any SSO that required reoperation, opening of the wound, suture excision, wound debridement, percutaneous drainage, or partial or complete mesh removal. 43,44 The sample size was based on the incidence of FD in the first 30 postoperative days expected for high-risk patients undergoing emergency laparotomy, which was considered 12.3%. [1][2][3][4][5]14 We predicted the rate of FD in the PMG to be 0%, based on retrospective studies in which prophylactic mesh was used in emergency operations.…”

Section: Fdmentioning

confidence: 99%

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Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Lima

Rasslan

Novo

et al. 2020

Journal of the American College of Surgeons

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BACKGROUND: Fascial dehiscence (FD) occurs in up to 14.9% of high-risk patients undergoing emergency laparotomy. Although prophylactic mesh can prevent FD, its use in emergency operations remains controversial. STUDY DESIGN: A prospective randomized clinical trial was conducted at the Hospital das Clínicas from Faculdade de Medicina da Universidade de São Paulo in Brazil. It was performed among highrisk patients, defined according to Rotterdam risk model, undergoing midline emergency laparotomy. The patients were randomized into the suture group (SG), with slowly absorbable running sutures placed with a 36-mm-long needle at a suture-to-wound length ratio of 4:1, and the prophylactic mesh group (PMG), with fascial closure as in the SG but reinforced with onlay polypropylene mesh. The primary end point was incidence of FD at 30 days post operation. RESULTS: We analyzed 115 patients; 52 and 63 were allocated to the SG and PMG, respectively. In all, 77.4% of the cases were for colorectal resection. FD occurred in 7 (13.5%) patients in the SG and none in the PMG (p ¼ 0.003). There was no difference between the groups in number of patients with surgical site occurrence (SSO) or SSO requiring procedural intervention. However, some specific SSOs had higher incidences in the mesh group: surgical site infection (20.6% versus 7.7%; p ¼ 0.05), seroma (19.0% versus 5.8%; p ¼ 0.03), and nonhealing incisional wound (23.8% versus 5.8%; p ¼ 0.008). Of SSOs in the PMG and SG, 92.3% and 73.3%, respectively, resolved spontaneously or with bedside interventions. CONCLUSIONS: Prophylactic onlay mesh reinforcement in emergency laparotomy is safe and prevents FD. Surgical site infection, seroma, and nonhealing incisional wound were more common in the mesh group, but associated with low morbidity within 30 days post operation.

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Section: Fdmentioning

confidence: 99%

Section: Fdmentioning

confidence: 99%

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Lima

Rasslan

Novo

et al. 2020

Journal of the American College of Surgeons

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“…Surgical site infection and SSOPI were defined using the standardized definitions for postoperative wound events after VHR as follows: An SSI is an infection that occurs in the part of the body where the operation took place (ie abdominal wall) and is further defined as superficial, deep, and organ space SSIs. [10][11][12] An SSOPI is any surgical site occurrence (including SSI) that requires opening of the wound, wound debridement, suture excision, percutaneous drainage, or partial or complete mesh removal. 10 Finally, ventral hernia recurrence was identified based on physical examination, radiographic assessment, or the Ventral Hernia Recurrence Inventory at 1 year after VHR.…”

Section: Outcomes Measures Of Interestmentioning

confidence: 99%

“…[10][11][12] An SSOPI is any surgical site occurrence (including SSI) that requires opening of the wound, wound debridement, suture excision, percutaneous drainage, or partial or complete mesh removal. 10 Finally, ventral hernia recurrence was identified based on physical examination, radiographic assessment, or the Ventral Hernia Recurrence Inventory at 1 year after VHR. 13 Statistical analysis A predictive model for each of the outcomes of interest was generated using logistic regression for the binary outcomes of interest (SSI, SSOPI, and 30-day readmission), Cox proportional hazards regression for 1-year hernia recurrence, and quasi-Poisson generalized linear regression for predicted LOS.…”

Section: Outcomes Measures Of Interestmentioning

confidence: 99%

Development and Validation of the Ventral Hernia Repair Outcomes Reporting App for Clinician and Patient Engagement (ORACLE)

Haskins

Olson

Stewart

et al. 2019

Journal of the American College of Surgeons

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BACKGROUND: Patient engagement is an increasingly important component of surgical decision making.Given the many factors associated with successful ventral hernia repair (VHR), we developed and validated the Outcomes Reporting App for Clinical and Patient Engagement (ORACLE) tool to help facilitate preoperative surgeon-patient discussions about VHR. METHODS:All patients undergoing elective, VHR with 30-day follow-up data available within the Americas Hernia Society Quality Collaborative were eligible for study inclusion. Using bootstrapping and bias-corrected calibration, predictive models were generated and validated for 5 quality measures after VHR, including postoperative wound events, estimated length of hospital stay, unplanned 30-day readmission to the hospital, and risk of hernia recurrence at 1 year postoperatively. RESULTS:A total of 10,690 patients met inclusion criteria. Based on comparison of the theoretical best to the observed calibration curves, the models for each of the 5 outcomes of interest have strong predictive strength as reflected in the Brier score for surgical site infection, surgical site occurrence requiring procedural intervention, and 30-day hospital readmission, the c-index for 1year hernia recurrence and the R 2 value for the model for predicted hospital length of stay. CONCLUSIONS: Using a national data set for development, ORACLE can be used to facilitate patient engagement, with the goal of tailoring interventions for VHR given each patient's unique factors.With ongoing data input into the Americas Hernia Society Quality Collaborative and a continuous re-evaluation of these risk models, it is our intention that this tool will serve as an up-todate resource for hernia surgeons and ventral hernia patients. (J Am Coll Surg 2019;229: 259e266. Ó

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“…Wound complications go hand in hand with any surgical procedure, but recently have been increasingly scrutinized as more detailed analyses of outcomes are demanded by providers, payers and patients alike. In this issue of Hernia, Dr. Haskins and associates, have published a stimulating and thought-provoking review of the nomenclature of wound complications using a unique analysis of the 50 most cited papers on ventral hernia repair from 1995 to 2015 [1]. With this group of papers serving as a surrogate for thoughtful and well-designed scientific papers of high quality, a striking absence of a common language with standardized definitions was identified.…”

mentioning

confidence: 99%

SSI, SSO, SSE, SSOPI: the elusive language of complications in hernia surgery

DeBord

Novitsky

Fitzgibbons

et al. 2018

Hernia

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A call for standardization of wound events reporting following ventral hernia repair

Cited by 114 publications

References 26 publications

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Development and Validation of the Ventral Hernia Repair Outcomes Reporting App for Clinician and Patient Engagement (ORACLE)

SSI, SSO, SSE, SSOPI: the elusive language of complications in hernia surgery

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