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Stopping prehospital chlorhexidine skin wash does not increase wound morbidity after incisional hernia repair: results of a 4-year quality improvement initiative

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Abstract

Background

Prehospital chlorhexidine gluconate (CHG) skin washes are used to prevent wound complications, but little evidence supports this practice in hernia surgery. A propensity-matched retrospective review published by our group in 2016 found that prehospital CHG was associated with an increased risk of surgical site occurrences (SSO) and surgical site infections (SSI) after ventral hernia repair. Prehospital CHG was, therefore, abandoned by three of five surgeons at the Cleveland Clinic Foundation (CCF) by April 2017. We aimed to determine if discontinuation of prehospital CHG affected wound morbidity rates after incisional hernia repair.

Methods

The Abdominal Core Health Quality Collaborative was queried for all patients who underwent open, clean incisional hernia repairs with 30-day follow-up from 2014 to 2019. Using an interrupted time series (ITS) analysis model adjusted for group and mean propensity score, wound morbidity before and after April 1, 2017 (start of Q2) was compared between three groups: CCF surgeons who abandoned prehospital CHG (Group 1), CCF surgeons who continued using prehospital CHG (Group 2), and non-CCF surgeons using prehospital CHG (Group 3). Outcomes included rates of SSOs, SSIs, and surgical site occurrences requiring procedural intervention (SSOPI) at 30 days.

Results

In total, 4276 patients were included in the analysis (Group 1: 339 before Q2 vs 673 after Q2; Group 2: 211 before Q2 vs 175 after Q2; Group 3: 1312 before Q2 vs 1566 after Q2). Rates of SSO, SSIs, and SSOPIs at 30 days were similar across all three groups before and after prehospital CHG discontinuation.

Conclusion

Stopping prehospital CHG wash did not result in increased wound morbidity after open, clean, incisional hernia repair. We have abandoned CHG use in this context.

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Data availability statement

Data is available from the corresponding author upon request.

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Authors and Affiliations

  1. Department of Surgery, Cleveland Clinic Center for Abdominal Core Health Cleveland Clinic Foundation, Cleveland, OH, USA

    B. T. Miller, C. C. Petro, L. R. A. Beffa, M. J. Rosen, D. M. Krpata & A. S. Prabhu

  2. Biostatistics Department, Vanderbilt University Medical Center, Nashville, TN, USA

    S. Phillips

  3. Department of Surgery, Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    B. K. Poulose

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  1. B. T. Miller
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  2. S. Phillips
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  8. A. S. Prabhu
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Contributions

BTM contributed to study design, data acquisition and interpretation, manuscript writing, and final approval. SP contributed to statistical analysis, manuscript writing, and final approval. BKP, CCP, LRAB, MJR, DMK, and ASP contributed to study design, data interpretation, manuscript revision, and final approval.

Corresponding author

Correspondence to B. T. Miller.

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Conflict of interest

Benjamin K. Poulose MD, MPH receives salary support as the Abdominal Core Health Quality Collaborative Director of Quality and Outcomes and has research support paid to the institution from BD Interventional and Advanced Medical Solutions. Dr. Lucas R. A. Beffa has received honoraria from Intuitive Surgical. Dr. Michael J. Rosen receives salary support as medical director of the Abdominal Core Health Quality Collaborative and is a board member of Ariste Medical with stock options. Dr. Ajita S. Prabhu is a member of the CMR Surgical Medical Advisory Board. Drs. Benjamin T. Miller, Sharon Phillips, Clayton C. Petro, and David M. Krpata have no conflicts of interest or financial ties to disclose.

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Ethical approval for this study was obtained from the Cleveland Clinic Foundation Institutional Review Board.

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Miller, B.T., Phillips, S., Poulose, B.K. et al. Stopping prehospital chlorhexidine skin wash does not increase wound morbidity after incisional hernia repair: results of a 4-year quality improvement initiative. Hernia 27, 575–582 (2023). https://doi.org/10.1007/s10029-022-02722-7

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