Stratification of surgical site infection by operative factors and comparison of infection rates after hernia repair

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.

Conflict of interest statement

Potential conflicts of interest

DKW reports consultant work with Centene Corp., Sagentia Inc., and Novaerus Inc. for work outside the submitted manuscript. VJF reports personal fees from Battelle outside the submitted manuscript; her spouse is employed by Express Scripts. MAO reports consultant work with Pfizer and Sanofi Pasteur and grant funding through Cubist Pharmaceuticals and Sanofi Pasteur for work outside the submitted manuscript. All other authors report no conflicts of interest relevant to this article.