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Postoperative surgical site infections after ventral/incisional hernia repair: a comparison of open and laparoscopic outcomes

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Abstract

Background

The purpose of this study was to compare the incidence of postoperative surgical site infections (SSIs), operative times (OTs), and length of hospital stay (LOS) after open and laparoscopic ventral/incisional hernia repair (VIHR) using multicenter, prospectively collected data.

Methods

The incidence of postoperative SSIs, OTs, and LOS was determined for cases of VIHR in the American College of Surgeons’ National Surgical Quality Improvement Program database in 2009 and 2010. Open and laparoscopic techniques were compared using a propensity score model to adjust for differences in patient demographics, characteristics, comorbidities, and laboratory values.

Results

A total of 26,766 cases met the inclusion criteria; 21,463 cases were open procedures (reducible, n = 15,520 [72 %]; incarcerated/strangulated, n = 5,943 [28 %]), and 5,303 cases were laparoscopic procedures (reducible, n = 3,883 [73 %]; incarcerated/strangulated, n = 1,420 [27 %]). Propensity score adjusted odds ratios (ORs) were significantly different between open and laparoscopic VIHR for reducible and incarcerated/strangulated hernias with regard to superficial SSI (OR 5.5, p < 0.01 and OR 3.1, p < 0.01, respectively), deep SSI (OR 6.9, p < 0.01, and OR 8.0, p < 0.01, respectively) and wound disruption (OR 4.6, p < 0.01 and OR 9.3, p = 0.03, respectively). The risk for organ/space SSI was significantly greater for open operations among reducible hernias (OR 1.9, p = 0.02), but there was no significant difference between the open and laparoscopic repair groups for incarcerated/strangulated hernias (OR 0.8, p = 0.41). The OT was significantly longer for laparoscopic procedures, both for reducible (98.5 vs. 84.9 min, p < 0.01) and incarcerated/strangulated hernias (96.4 vs. 81.2 min, p < 0.01). LOS (mean, 95 % confidence interval) was significantly longer for open repairs for both reducible (open = 2.79, 2.59–3.00; laparoscopic = 2.39, 2.20–2.60; p < 0.01) and incarcerated/strangulated (open = 2.64, 2.55–2.73; laparoscopic = 2.17, 2.02–2.33; p < 0.01) hernias.

Conclusions

Laparoscopic VIHR for reducible and incarcerated/strangulated hernias is associated with shorter LOS and decreased risk for superficial SSI, deep SSI, and wound disruption, but longer OTs when compared to open repair.

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Disclosures

Drs. Christodoulos Kaoutzanis, Stefan W. Leichtle, Nicolas J. Mouawad, Richard M. Lampman, and Robert K. Cleary, and Ms. Kathleen B. Welch have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Reichert Health Building, Suite R-2111, Ann Arbor, MI, 48106, USA

    Christodoulos Kaoutzanis, Stefan W. Leichtle, Nicolas J. Mouawad, Richard M. Lampman & Robert K. Cleary

  2. Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA

    Kathleen B. Welch

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  1. Christodoulos Kaoutzanis
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  2. Stefan W. Leichtle
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Correspondence to Christodoulos Kaoutzanis.

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Kaoutzanis, C., Leichtle, S.W., Mouawad, N.J. et al. Postoperative surgical site infections after ventral/incisional hernia repair: a comparison of open and laparoscopic outcomes. Surg Endosc 27, 2221–2230 (2013). https://doi.org/10.1007/s00464-012-2743-0

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