K. Coakley1, S. Groene1, T. Prasad1, A. Lincourt1, K. Kercher1, V. Augenstein1, B. Heniford1, P. Colavita1 1Carolinas Medical Center,GI And Minimally Invasive Surgery,Charlotte, NC, USA
Introduction:
Surgical site infections (SSI) remain a common problem in the postoperative hernia patient. These infections add to healthcare costs, however little is known on how SSI impact patient’s quality of life (QOL) following an open ventral hernia repair (OVHR). Our aim was to assess the effects of SSI on surgical and QOL outcomes following OVHR.
Methods:
A query of a prospective, single-center, hernia-specific database was performed for adult OVHR. Demographics, operative characteristics, and complications were analyzed using standard statistical methods. Multivariate regression (MVR) was performed for outcomes controlling for BMI, defect size, and comorbidities. QOL was evaluated pre-operatively, at 2 and 4 weeks, as well as 6- and 12-months using the Carolinas Comfort Scale, a hernia specific assessment tool used to evaluate QOL outcomes.
Results:
A total of 1,711 OVHR with 239 SSI (14%) were identified. SSI were seen in patients with a larger BMI (37.0±9.1 vs 32.0±10.6kg/m2; p<0.001) and more comorbidities(3.2±2.2 vs 2.9±2.2;p=0.03). Patients with SSI’s had larger hernia defects (241.6±242.4 vs 134.2±226.0cm2; p=<0.001), longer OR time (228.0±94.3 vs 150.4±92.0min; p<0.001), and greater EBL (217.3±286.7 vs 97.9±125.2mL; p<0.001). Table 1 includes additional variables. Patients with SSI overall had more postoperative complications beyond SSI (72.9 vs 34.9%; p<0.001), specifically mesh infection (9.3 vs 0.3%;p<0.001), unplanned return to the OR(25.1 vs 3.7%;p<0.001), wound breakdown(36.9 vs 6.1%;p<0.001), readmission in 30 days(41.6 vs 5.9%;p<0.001) and recurrence(18.8 vs 4.5%;p<0.001). There was no difference in 30-day mortality. MVR demonstrated SSI was an independent predictor of recurrence when controlling for BMI, defect size and comorbidities (Odds Ratio(OR) 4.82; 95% CI 2.725-8.55). . At 6 months, SSI was an independent predictor of worse mesh sensation (OR 2.831; 95% CI 1.421-5.640), movement limitation (OR 2.083; 95% CI 1.035-4.192) and overall QOL (OR 2.355; 95% CI 1.174- 4.724). At 1 year, SSI was independently associated with overall decreased QOL (OR 2.284; 95% CI 1.134-4.600).
Conclusion:
SSI is associated with recurrence and worse quality of life in univariate and multivariate analysis. Consistently, OVHR patients who experienced an SSI reported worse QOL scores at all follow up time points, from 2 weeks to 12 months. Efforts to reduce SSI should be strongly pursued to reduce hernia recurrence and improve patient quality of life.
