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Stratification of Surgical Site Infection by Operative Factors and Comparison of Infection Rates after Hernia Repair

Published online by Cambridge University Press:  22 December 2014

Margaret A. Olsen ,
Katelin B. Nickel ,
Anna E. Wallace ,
Daniel Mines ,
Victoria J. Fraser  and
David K. Warren
Margaret A. Olsen*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
Katelin B. Nickel
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Anna E. Wallace
Affiliation:
HealthCore, Inc., Wilmington, Delaware
Daniel Mines
Affiliation:
HealthCore, Inc., Wilmington, Delaware
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
David K. Warren
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
*
Address correspondence to Margaret A. Olsen, PhD, MPH, Washington University School of Medicine, Division of Infectious Diseases, Campus Box 8051, 660 S. Euclid Ave., St. Louis, MO 63110 ([email protected]).
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Abstract

Objective

To investigate whether operative factors are associated with risk of surgical site infection (SSI) after hernia repair.

Design

Retrospective cohort study.

Patients

Commercially insured enrollees aged 6 months-64 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure or Current Procedural Terminology, fourth edition, codes for inguinal/femoral, umbilical, and incisional/ventral hernia repair procedures from January 1, 2004, through December 31, 2010.

Methods

SSIs within 90 days after hernia repair were identified by diagnosis codes. The χ2 and Fisher exact tests were used to compare SSI incidence by operative factors.

Results

A total of 119,973 hernia repair procedures were analyzed. The incidence of SSI differed significantly by anatomic site, with rates of 0.45% (352/77,666) for inguinal/femoral, 1.16% (288/24,917) for umbilical, and 4.11% (715/17,390) for incisional/ventral hernia repair. Within anatomic sites, the incidence of SSI was significantly higher for open versus laparoscopic inguinal/femoral (0.48% [295/61,142] vs 0.34% [57/16,524], P=.020) and incisional/ventral (4.20% [701/16,699] vs 2.03% [14/691], P=.005) hernia repairs. The rate of SSI was higher following procedures with bowel obstruction/necrosis than procedures without obstruction/necrosis for open inguinal/femoral (0.89% [48/5,422] vs 0.44% [247/55,720], P<.001) and umbilical (1.57% [131/8,355] vs 0.95% [157/16,562], P<.001), but not incisional/ventral hernia repair (4.01% [224/5,585] vs 4.16% [491/11,805], P=.645).

Conclusions

The incidence of SSI was highest after open procedures, incisional/ventral repairs, and hernia repairs with bowel obstruction/necrosis. Stratification of hernia repair SSI rates by some operative factors may facilitate accurate comparison of SSI rates between facilities.

Infect Control Hosp Epidemiol 2014;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 3 , March 2015 , pp. 329 - 335
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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