Predictive factors of surgical site infections in abdominal wall hernias

Abstract

INTRODUCTIONSurgical site infection is a disastrous adverse event both for the patient and surgeon especially after clean surgeries with the placement of a mesh in abdominal wall hernia surgeries. It increases post-operative morbidity, prolongs hospital stay and increases hospital cost. Surgical site infection is categorized broadly as nosocomial infection acquired during hospital stay. The exact source of infection is difficult to trace.1 It develops where medical and paramedical staff is in close contact with the patient at various stages of treatment. About 25-35% of these infections would be prevented by adhering to strict asepsis guidelines. 2Factors associated with surgical site infection include patient factors like co-morbid illness, age, gender, smoking, length of preoperative stay, nature of surgery and factors associated with the operating surgeon like the duration of surgery, seniority of surgeon and the placement of mesh. All these factors are because of a disturbed host-bacteria equilibrium that is in favour of the bacteria and lead to SSI. Carrying out a SSI estimation study for all surgical patients is the need of the hour but, the present study focuses on anterior abdominal wall ABSTRACT Background: Surgical site infections (SSI) are infections presents in any location along the surgical tract after a surgical procedure. Knowledge of predictive factors associated with SSI is important for planning remedial measures. Abdominal wall hernia repair is a common procedure in general surgery practice and knowing the predictors of SSI in these clean surgeries requiring placement of mesh is the aim of the present study. Methods: In a hospital based longitudinal study the subjects were diagnosed cases of anterior abdominal wall hernias undergoing planned or emergency surgeries. Patients of either gender and age group of 18 to 80 years were included in the study. Patients undergoing laparoscopic hernia repair were excluded. The study factors were patient and the surgeon related factors like laboratory parameters, surgeon experience etc. The outcome was SSI assessed with up to 30 days post-operative follow up. Results: Total 198 patients were enrolled with a mean age of 42.49±15.72 years and male preponderance. Overall SSI rate was 9.09% and in planned cases it was 7.07% and 50% in emergency cases. Pre-operative hospital stays of >5 days was the only patient factor associated with increased risk of SSI (p=0.0004) and operating surgeon's experience was associated with increased risk if SSI i.e. cases operated by junior surgeons had a higher risk of SSI (p=0.013). Conclusions:The only modifiable factor associated with SSI was pre-operative hospital stay of >5 days while high incidence of SSI with junior surgeons cannot be modified in a teaching institute.

Surgical site infections in emergency abdominal surgeries in a tertiary care hospital of North-East India

“…4,5 In a study by Ansul et al 13% were male and 12% were female. 6 Highest incidence of SSI was observed in patients aged 50 years or more (44.34%) and lowest rate in the group 13-19 years and the incidence was high when associated with co-morbidities, in our study, which is similar to studies done by Narsinga Rao Bandaro et al and Keswani et al 7,8 Duration of operation was found to be an important risk factor in the development of SSI in this study with highest 63.33% cases where the operation lasted for>120 minutes. Haley et al also found operative time of>2 hrs as an important factor in the development of SSI.…”

Outcomes of Emergency Abdominal Wall Hernia Repair: Experience Over a Decade

“…In a study by Nieuwenhuizen et al, 203 patients underwent acute hernia repair, and the overall SSI rate was 12.3% [18]. In one of the Indian studies by Keswani et al, where 198 patients with abdominal wall hernia were analyzed, SSI was observed in 7% of elective surgeries and in almost 50% of emergency surgeries [19]. Emile et al observed that the SSI rate was higher (7.5%) in the mesh group than in the tissue repair group (5.3%) [15].…”

A prospective study of the bacteriological profile and risk factors of infection after internal fixation of close fractures of long bones

“…Rate of infection among male patients was 13.96% and among female patients was 9.23%. Razavi et al, Chang et al, Kumar et al, Keswani et al and Khosravi et al found male cases more commonly infected 8,[13][14][15][16]. However, the studies by Raf, Lidgren et al showed either sex can develop infection equally 17,18.…”