Original Article


, Volume 19, Issue 1, pp 113-123

First online:

Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair

  • C. KaoutzanisAffiliated withDepartment of Surgery, Saint Joseph Mercy Health System Email author 
  • , S. W. LeichtleAffiliated withDepartment of Surgery, Saint Joseph Mercy Health System
  • , N. J. MouawadAffiliated withDepartment of Surgery, Saint Joseph Mercy Health System
  • , K. B. WelchAffiliated withCenter for Statistical Consultation and Research, University of Michigan
  • , R. M. LampmanAffiliated withDepartment of Surgery, Saint Joseph Mercy Health System
  • , W. L. WahlAffiliated withDepartment of Surgery, Saint Joseph Mercy Health System
  • , R. K. ClearyAffiliated withDepartment of Surgery, Saint Joseph Mercy Health System

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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.

Study design

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.


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/m2, 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.


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.


Ventral hernia Incisional hernia Ventral/incisional hernia repair Postoperative surgical site infection Length of hospital stay ACS-NSQIP