Risks and Prevention of Surgical Site Infection After Hernia Mesh Repair and the Predictive Utility of ACS-NSQIP

Abstract

Aim The aim of this paper was to provide a narrative review of surgical site infection after hernia surgery and the influence of perioperative preventative interventions. Methods The review was based on current national and international guidelines and a literature search. Results Mesh infection is a highly morbid complication after hernia surgery, and is associated with hospital re-admission, increased health care costs, re-operation, hernia recurrence, impaired quality of life and plaintiff litigation. The American College of Surgeons National Surgical Quality Improvement Program is a particularly useful resource for the study and evidence-based practise of abdominal wall hernia repair. Discussion The three major modifiable patient comorbidities significantly associated with postoperative surgical site infection in hernia surgery are obesity, tobacco smoking and diabetes mellitus. Preoperative optimization includes weight loss, cessation of smoking, and control of diabetes. Intraoperative interventions relate, in particular, to the control of fomite mediated transmission in the operating theatre and prevention of mesh contamination with S. aureus CFUs. Risk management strategies should also target the niche ecological conditions which enable bacterial survival and subsequent biofilm formation on an implanted mesh. Outcomes of mesh infection after hernia surgery are closely related to mesh type and porosity, patient smoking status, presence of MRSA, bacterial adhesion and biofilm production. The use of suction drains and the timing of drain removal are controversial and discussed in detail. Finally, the utility of the ACS-NSQIP Surgical Risk Calculator in predicting complications and outcomes in individual patients and the importance of quality improvement initiatives in surgical units are emphasized.

Surgical site infections after emergency hernia repair: substudy from the Management of Acutely Symptomatic Hernia (MASH) study

“…SSI was most commonly seen in those with increased BMI and incisional hernia. Previous work has demonstrated the association of these factors with subsequent SSI 13 , 14 . While these factors, along with diabetes mellitus and smoking status are preferably optimized in the elective setting, there is no meaningful opportunity to mitigate these risks in the acute setting.…”

Infection and Recurrence Rates in Rural Inguinal Hernia Repair

“…In previous studies, smoking had been shown to be a modifiable risk factor for complications following hernia repair. 10 , 18 There were two patients who together cumulated 6 of the 14 total complications. Both of these patients had morbid obesity (a BMI of ≥ 40), which also has been shown to be a modifiable risk factor.…”

“…Emergent procedures were excluded because a mesh is not placed due to the high risk for harboring infection. 10 Additionally, not placing a mesh had been shown to have higher hernia recurrence rates.…”

Modern Approaches in Treatment of Patients With Chronic Mesh Infection After Abdominal Wall Repair

“…По данным современных авторов, риск развития последних закономерно возрастает с повышением объема и сложности вмешательства, определяемого размерами грыжевого дефекта и характеристиками клинического случая, включая класс зоны операции согласно классификации US Centers for Disease Control and Prevention [9]. Достоверными факторами риска инфекции эндопротеза являются класс пациента III и более по классификации American Society of Anesthesiologists, пожилой возраст, курение, хроническая обструктивная болезнь легких, морбидное ожирение, предшествующие инфекции в зоне вмешательства, продолжительность операции, непреднамеренная энтероили колотомия, наличие свищей [10,11,12]. Вмешательства на кишечнике одновременно с протезирующей пластикой сопровождаются достоверно худшими результатами [13,14].…”

“…Известно также о влиянии на риск иммунодепрессивных препаратов, глюкокортикостероидов, сахарного диабета и ряда других коморбидных заболеваний [11][12][13][14][15]. Экстренный характер вмешательства, открытый доступ по сравнению с лапароскопическим также являются факторами риска [11,13,16].…”