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Stratification of Surgical Site Infection by Operative Factors and Comparison of Infection Rates after Hernia Repair
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Details:
  • Pubmed ID:
    25695175
  • Pubmed Central ID:
    PMC4683022
  • Funding:
    5R01HS019713/HS/AHRQ HHS/United States
    U54 CK000162/CK/NCEZID CDC HHS/United States
    U54CK000162/CK/NCEZID CDC HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    Objective

    The National Healthcare Safety Network does not risk adjust surgical site infection (SSI) rates after hernia repair by operative factors. We investigated whether operative factors are associated with risk of SSI after hernia repair.

    Design

    Retrospective cohort study.

    Patients

    Commercially-insured enrollees aged 6 months–64 years with ICD-9-CM procedure or CPT-4 codes for inguinal/femoral, umbilical, and incisional/ventral hernia repair procedures from 1/1/2004–12/31/2010.

    Methods

    SSIs within 90 days after hernia repair were identified by ICD-9-CM diagnosis codes. Chi-square and Fisher’s exact tests were used to compare SSI incidence by operative factors.

    Results

    A total of 119,973 hernia repair procedures were included in the analysis. 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] versus 0.34% [57/16,524], p=0.020) and incisional/ventral (4.20% [701/16,699] versus 2.03% [14/691], p=0.005) 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] versus 0.44% [247/55,720], p<0.001) and umbilical (1.57% [131/8,355] versus 0.95% [157/16,562], p<0.001), but not incisional/ventral hernia repair (4.01% [224/5,585] versus 4.16% [491/11,805], p=0.645).

    Conclusions

    The incidence of SSI was highest after open procedures, incisional/ventral repairs, and hernia repairs with bowel obstruction/necrosis. Our findings suggest that stratification of hernia repair SSI rates by some operative factors may be important to facilitate accurate comparison of SSI rates between facilities.