title: Obstructing ventral hernias are not independently associated with surgical site infections.
abstract: BACKGROUND
  Delayed operative intervention in the setting of adhesive bowel obstruction has been recently shown to increase the rate of surgical site infection (SSI), raising the concern for bacterial translocation. The effect of obstruction on SSI rate in patients with ventral hernia is unknown. The aim of this study was to assess the association between bowel obstruction and SSI in patients undergoing ventral hernia repair (VHR).
  
  
  METHODS
  This study is a retrospective database review. Patients undergoing isolated VHR from 2005-2011 were identified from the American College of Surgeons' National Surgical Quality Improvement Program database. Demographics, comorbidities, and 30-d outcomes were analyzed. Multivariate logistic regression was used for variables with a P value of <0.1.
  
  
  RESULTS
  A total of 68,811 patients underwent isolated VHR; 53.1% were male with mean age of 53 ± 15 y and body mass index of 32 ± 8. Hernia-related obstruction was found in 17,058 (24.8%). In patients with obstruction, SSI was more frequent (3.2% versus 2.6%, P < 0.001). Obesity, advanced age, vascular, pulmonary, hepatic, renal disease, and diabetes were more prevalent. After controlling for confounding baseline variables, bowel obstruction was not independently associated with SSI (odds ratio, 0.983, 95% confidence interval, 0.872-1.107). Subgroup analysis of clean classified cases also demonstrated the lack of independent association between obstruction and SSI.
  
  
  CONCLUSIONS
  Obstruction in patients undergoing VHR is not independently associated with SSI. Our results suggest that mesh implantation remains a viable option in this setting. Other confounding comorbid conditions should be assessed at the time of surgical intervention to identify patients appropriate for mesh repair.
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina.
authors.forename: Megan
authors.initials: M
authors.lastname: Sippey
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina.
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Mozer
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina.
authors.forename: Marysia
authors.initials: M
authors.lastname: Grzybowski
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Manwaring
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Kasten
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Gina L
authors.initials: GL
authors.lastname: Adrales
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina.
authors.forename: Walter E
authors.initials: WE
authors.lastname: Pofahl
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina. Electronic address: spaniolask@ecu.edu.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spaniolas
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000150:complications / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology*
keywords: Obstruction; Surgical site infection; Ventral hernia repair