Evaluation of surgical site infection surveillance as a Prognostic Tool in incisional hernia

Sean Kelly; S. Doyle; L. Walsh

doi:10.5281/zenodo.22813401

Authors

Sean Kelly Department of General Surgery, Neva Research Center for General Surgery Author https://orcid.org/1269-1793-3054-8916
S. Doyle Division of General Surgery, Ob Academy of Surgical Research Author https://orcid.org/2076-1215-0426-8028
L. Walsh Division of General Surgery, Neva Research Center for General Surgery Author https://orcid.org/5525-7975-9514-0854

DOI:

https://doi.org/10.5281/zenodo.22813401

Keywords:

surgical site infection, incisional hernia, surveillance, hernia recurrence, mesh

Abstract

Graphical abstract

Background: Surgical site infection is the most common complication after incisional hernia repair and is widely used as a prognostic marker for subsequent hernia recurrence, but the surveillance method used to ascertain infection status varies considerably across studies and institutions.

Objective: To evaluate whether surveillance methodology changes both the detected 90-day surgical site infection rate and the strength of the association between infection status and hernia recurrence after incisional hernia repair.

Methods: In a retrospective cohort of 587 adults undergoing elective open incisional hernia repair with mesh, surgical site infection was ascertained in parallel by passive, chart-based surveillance and by active, structured surveillance combining telephone follow-up and outside-encounter linkage. Cox proportional hazards regression assessed the infection-recurrence association under each method.

Results: Active surveillance detected surgical site infection in 13.5% of patients versus 7.2% under passive surveillance (p<0.001). The adjusted hazard ratio for recurrence associated with infection was 3.1 using active surveillance versus 2.1 using passive surveillance, and deep or organ/space infection carried a markedly higher recurrence hazard than superficial infection.

Conclusions: Surveillance intensity materially affects both detected surgical site infection rates and the apparent strength of infection as a prognostic marker for hernia recurrence; active surveillance and attention to infection depth substantially sharpen its prognostic value.

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