Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Institute of Microbiology, Infectious Diseases and Immunology (I-MIDI), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Surg Endosc. 2023 Sep;37(9):6885-6894. doi: 10.1007/s00464-023-10144-4. Epub 2023 Jun 13.
Prophylactic intra-abdominal onlay mesh (IPOM) implantation has been shown to reduce the rate of fascial dehiscence and incisional hernia. However, surgical site infection (SSI) in presence of an IPOM remains a concern. The aim of this study was to assess predictors for SSI following IPOM placement in hernia and non-hernia abdominal surgery in clean and contaminated surgical fields.
Observational study including patients undergoing IPOM placement at a Swiss tertiary care hospital 2007-2016. IPOM implantation was performed in hernia and non-hernia elective and emergency abdominal surgery, including contaminated and infected surgical fields. The incidence of SSI was prospectively assessed by Swissnoso according to CDC criteria. The effect of disease- and procedure-related factors on SSI was assessed in multivariable regression analysis, adjusting for patient-related factors.
A total of 1072 IPOM implantations were performed. Laparoscopy was performed in 415 patients (38.7%), laparotomy in 657 patients (61.3%). SSI occurred in 172 patients (16.0%). Superficial, deep, and organ space SSI were found in 77 (7.2%), 26 (2.4%), and 69 (6.4%) patients, respectively. Multivariable analysis revealed emergency hospitalization (OR 1.787, p = 0.006), previous laparotomy (1.745, p = 0.029), duration of operation (OR 1.193, p < 0.001), laparotomy (OR 6.167, p < 0.001), bariatric (OR 4.641, p < 0.001), colorectal (OR 1.941, p = 0.001), and emergency (OR 2.510, p < 0.001) surgery, wound class ≥ 3 (OR 3.878, p < 0.001), and non-polypropylene mesh (OR 1.818, p = 0.003) as independent predictors for SSI. Hernia surgery was independently associated with a lower risk for SSI (OR 0.165, p < 0.001).
This study revealed emergency hospitalization, previous laparotomy, duration of operation, laparotomy, as well as bariatric, colorectal, and emergency surgery, abdominal contamination or infection, and usage of non-polypropylene mesh as independent predictors for SSI. In contrast, hernia surgery was associated with a lower risk for SSI. The knowledge of these predictors will help to balance benefits of IPOM implantation against the risk for SSI.
预防性腹腔内覆盖网（IPOM）植入已被证明可降低筋膜裂开和切口疝的发生率。然而，在 IPOM 存在的情况下，手术部位感染（SSI）仍然是一个关注点。本研究旨在评估清洁和污染手术区域中疝和非疝腹部手术中 IPOM 放置后 SSI 的预测因素。
这是一项在瑞士一家三级护理医院进行的观察性研究，纳入了 2007 年至 2016 年间接受 IPOM 植入的患者。在择期和急诊腹部手术中，包括污染和感染手术区域，进行了疝和非疝 IPOM 植入。根据 CDC 标准，瑞士诺索斯前瞻性评估 SSI 的发生率。在多变量回归分析中，调整患者相关因素后，评估疾病和手术相关因素对 SSI 的影响。
共进行了 1072 例 IPOM 植入术。415 例（38.7%）患者行腹腔镜手术，657 例（61.3%）患者行剖腹手术。172 例（16.0%）患者发生 SSI。分别有 77 例（7.2%）、26 例（2.4%）和 69 例（6.4%）患者发生浅表、深部和器官间隙 SSI。多变量分析显示，急诊住院（OR 1.787，p=0.006）、既往剖腹手术（OR 1.745，p=0.029）、手术时间（OR 1.193，p<0.001）、剖腹手术（OR 6.167，p<0.001）、减重（OR 4.641，p<0.001）、结直肠（OR 1.941，p=0.001）和急诊（OR 2.510，p<0.001）手术、伤口分类≥3（OR 3.878，p<0.001）和非聚丙烯网（OR 1.818，p=0.003）是 SSI 的独立预测因素。疝手术与 SSI 风险降低独立相关（OR 0.165，p<0.001）。
本研究显示，急诊住院、既往剖腹手术、手术时间、剖腹手术、减重、结直肠和急诊手术、腹部污染或感染以及非聚丙烯网的使用是 SSI 的独立预测因素。相反，疝手术与 SSI 风险降低相关。了解这些预测因素将有助于平衡 IPOM 植入的益处与 SSI 的风险。
