title: Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair.
abstract: OBJECTIVE
  The purpose of this study was to identify predictive factors for postoperative surgical site infections (SSIs), and increased length of hospital stay (LOS) after ventral/incisional hernia repair (VIHR) using multi-center, prospectively collected data.
  
  
  METHODS
  Cases of VIHR from 2009 to 2010 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Using logistic regression, a prediction model utilizing 41 variables was developed to identify risk factors for postoperative SSIs, and increased LOS. Separate analyses were carried out for reducible and incarcerated/strangulated cases.
  
  
  RESULTS
  A total of 28,269 cases of VIHR were identified, 25,172 of which met inclusion criteria. 18,263 cases were reducible hernias, and 6,909 cases were incarcerated/strangulated hernias. Our prediction model demonstrated that body mass index ≥30 kg/m(2), smoking, American Society of Anesthesiology (ASA) class 3, open surgical approach, prolonged operative times, and inpatient admission following VIHR were significant predictors of postoperative SSIs. In addition, risk factors associated with prolonged LOS included older age, African American ethnicity, history of alcohol abuse, ASA classes 3 and 4, poor functional status, operation within the last 30 days of the index operation, history of chronic obstructive pulmonary disease, congestive heart failure, and bleeding disorder, as well as open surgical approach, non-involvement of residents, prolonged operative times, recurrent hernia, emergency operation, and low preoperative serum albumin level.
  
  
  CONCLUSIONS
  Obesity and smoking are modifiable risk factors for SSIs after VIHR, whereas a low serum albumin level is a modifiable risk factor for prolonged LOS. Addressing factors preoperatively might improve patient outcome, and reduce health care expenditures associated with VIHR. In addition, if feasible, the laparoscopic approach should be strongly considered.
authors.affiliation: Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Reichert Health Building, Suite R-2111, Ann Arbor, MI, 48106, USA, ckaoutzanis@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Kaoutzanis
authors.forename: S W
authors.initials: SW
authors.lastname: Leichtle
authors.forename: N J
authors.initials: NJ
authors.lastname: Mouawad
authors.forename: K B
authors.initials: KB
authors.lastname: Welch
authors.forename: R M
authors.initials: RM
authors.lastname: Lampman
authors.forename: W L
authors.initials: WL
authors.lastname: Wahl
authors.forename: R K
authors.initials: RK
authors.lastname: Cleary
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology
references.citation: Ann Surg. 1998 Oct;228(4):491-507
references.pmid: 9790339
references.citation: J Laparoendosc Adv Surg Tech A. 2000 Apr;10(2):79-84
references.pmid: 10794211
references.citation: Surg Endosc. 2006 Jul;20(7):1030-5
references.pmid: 16703430
references.citation: Cochrane Database Syst Rev. 2011 Mar 16;(3):CD007781
references.pmid: 21412910
references.citation: World J Surg. 2003 Jun;27(6):741-3
references.pmid: 12724826
references.citation: Ann Surg. 2004 Oct;240(4):578-83; discussion 583-5
references.pmid: 15383785
references.citation: Am J Surg. 2001 Nov;182(5):455-9
references.pmid: 11754850
references.citation: N Engl J Med. 2000 Aug 10;343(6):392-8
references.pmid: 10933738
references.citation: Adv Skin Wound Care. 2004 Oct;17(8):426-35
references.pmid: 15492679
references.citation: World J Surg. 2007 Dec;31(12):2398-404
references.pmid: 17952701
references.citation: J Am Coll Surg. 2004 Oct;199(4):531-7
references.pmid: 15454134
references.citation: J Thorac Cardiovasc Surg. 1999 Nov;118(5):866-73
references.pmid: 10534692
references.citation: Hernia. 2004 May;8(2):121-6
references.pmid: 14625699
references.citation: Am J Surg. 2005 Nov;190(5):676-81
references.pmid: 16226938
references.citation: ANZ J Surg. 2008 Oct;78(10):903-6
references.pmid: 18959646
references.citation: Surg Today. 2010 Aug;40(8):763-71
references.pmid: 20676862
references.citation: Surg Infect (Larchmt). 2008 Apr;9(2):131-7
references.pmid: 18426345
references.citation: JSLS. 2007 Oct-Dec;11(4):408-14
references.pmid: 18237502
references.citation: Arch Surg. 2012 Apr;147(4):373-83
references.pmid: 22508785
references.citation: Surg Endosc. 2013 Jun;27(6):2221-30
references.pmid: 23389063
references.citation: J Surg Res. 2009 Apr;152(2):224-30
references.pmid: 18468640
references.citation: J Am Coll Surg. 1997 Oct;185(4):341-51
references.pmid: 9328382
references.citation: Ann Surg. 2003 Jul;238(1):1-5
references.pmid: 12832959
references.citation: Eur J Surg. 1997 Mar;163(3):191-8
references.pmid: 9085061
references.citation: Chirurgia (Bucur). 2012 Jan-Feb;107(1):47-51
references.pmid: 22480115
references.citation: Am J Surg. 2001 Feb;181(2):101-4
references.pmid: 11425048
references.citation: J Am Coll Surg. 2007 Apr;204(4):550-60
references.pmid: 17382213
references.citation: BMC Cancer. 2010 May 25;10:232
references.pmid: 20497581
references.citation: Ann Plast Surg. 2008 Sep;61(3):235-42
references.pmid: 18724119
references.citation: J Am Coll Surg. 2010 Jan;210(1):6-16
references.pmid: 20123325
references.citation: Br J Surg. 2009 Aug;96(8):851-8
references.pmid: 19591158
references.citation: Vital Health Stat 13. 2007 Dec;(165):1-209
references.pmid: 18350768
references.citation: J Surg Res. 2003 May 1;111(1):78-84
references.pmid: 12842451
references.citation: Ann Surg. 2002 Sep;236(3):344-53; discussion 353-4
references.pmid: 12192321
references.citation: JSLS. 2000 Apr-Jun;4(2):131-9
references.pmid: 10917120