Surgical site infection following elective mesh repair of inguinal hernia: an analysis of risk factors

Abstract

Background: Surgical site infection (SSI) is a complication of mesh repair of inguinal hernia (IH) with an increase in length of stay and costs. We investigated both controllable and non-controllable risk factors for SSI following elective mesh repair of IH. Methods: A retrospective analysis was conducted of 1177 adult patients who underwent elective mesh repair of IH (not receiving antibiotic prophylaxis) from January 2010 to September 2019. Demographics, surgical variables and laboratory data were extracted from the electronic medical records. Receiver operating characteristic (ROC) analysis was performed to determine the optimal threshold of continuous variables. Independent risk factors for SSI were identified by univariate and multivariate analyses. Results: In total, 647 open and 530 laparoscopic IH repairs were included. The overall SSI rate within 30 days after surgery was 3.2% (39/1342 hernias) in the absence of antibiotic prophylaxis. Both the preoperative neutrophil‐lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were negatively correlated with the postoperative period of SSI (r = -0.368, P = 0.021; r = -0.334, P = 0.038, respectively). On multivariate analyses, body mass index (BMI) > 24.6 kg/m 2 (odds ratio [OR], 1.152; 95% confidence interval [CI], 1.041-1.275), current smoker (OR, 4.226; 95% CI, 1.222-14.611), preoperative NLR > 1.97 (OR, 3.670; 95% CI, 1.675-8.041), and open approach (OR, 4.866; 95% CI, 1.877-12.618) were significantly related to postoperative SSI. Conclusion: The controllable risk factors (elevated BMI, current smoker) found out here may help to identify patients at high-risk of SSI, allowing targeted preventive measures. Preoperative NLR > 1.97 is a previous unrecorded predictor for SSI following elective mesh repair of IH. Further study is needed to ascertain the magnitude of their effect.

Preoperative factors influencing surgical site infections (SSIS) in inguinal hernia patients undergoing tension-free mesh hernia repair at regional public hospitals in Bali

“…A study conducted at The F Affiliated Hospital of Shantou University Medical College found that diabetes mellitus is one of the risk factors for SSI in inguinal hernia repair. 24 A systematic review showed a similar result, stating that diabetes mellitus is not only the independent risk factor for inguinal hernia repair but also other surgical procedural. 26 Diabetes mellitus causes a state of immunosuppression which puts the patients at a greater risk of infection, and microangiopathy, which leads to prolonged wound healing.…”

“…Other studies stated that obesity increases SSI risk as it causes prolonged wound healing and decreases subcutaneous oxygen levels during the operation. 24,25 Such as the previous two factors, the immune system also serves as a bridge between diabetes mellitus and SSI incidence. A study conducted at The F Affiliated Hospital of Shantou University Medical College found that diabetes mellitus is one of the risk factors for SSI in inguinal hernia repair.…”

The role of prophylactic antibiotics in elective inguinal tension‐free hernia repair: A systematic review and meta‐analysis

“…There are many influencing factors of surgical site infection. Some studies have listed the possible risk factors for surgical site infection in tension‐free hernia repair from two aspects: patient factors (age, nutritional status, history of diabetes, other organ infections, immunodeficiency, preoperative hospital stay, smoking history, obesity) and surgical factors (preoperative preparation, operation time, ventilation in the operating room, sterility of surgical instruments, surgical drainage and surgical skills); moreover, the researchers believed that the effect of improving surgical factors is much greater than that of the routine preventive application of antibiotics 57‐59 . From the subgroup analysis of the total incidence of surgical site infection in this meta‐analysis, it was found that seven studies in the past 10 years showed that the total incidence of surgical site infection in the AG was 3.7%, and that in the NAG was 3.2%.…”