Risk factors for wound morbidity after open retromuscular (sublay) hernia repair

Clayton C. Petro, Natasza M. Posielski, Siavash Raigani, Cory N. Criss, Sean Orenstein, Yuri W. Novitsky

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background Retrorectus repairs (RR) of abdominal wall hernias are growing in popularity, yet wound morbidity and predictors in this context have been characterized poorly. Models aimed at predicting wound morbidity typically do not control for technique and/or location of mesh. Our aim was to describe wound morbidity and risk factors specifically in the context of RR hernia repair. Our hypothesis was that the incidence of wound morbidity with mesh sublay would be less than predicted by a model that does not control for mesh position. Methods Consecutive RR hernia repairs with at least a 90-day follow-up were identified in our prospective database and analyzed. The primary outcome measures were the incidence of surgical-site occurrence (SSO) and surgical-site infection (SSI) via modern, standardized definitions. For predictors of SSO, statistical analysis was performed with univariate analysis, χ2, and logistic regression as well as multivariate regression. Results A total of 306 patients met the inclusion criteria. Eighty-four SSOs identified in 72 (23.5%) patients included 48 (15.7%) SSIs, 14 (4.6%) instances of wound cellulitis, 12 (3.9%) skin dehiscences, 6 (2.0%) seromas, and 4 (1.3%) hematomas but no instances of mesh excision or fistula formation. Treatment entailed antibiotics alone in 30 patients, 14 bedside drainage procedures, 9 radiographically assisted drainage procedures, and 10 returns to the operating room for debridement. After multivariate analysis, diabetes (OR 2.41), hernia width >20 cm (OR 2.49), and use of biologic mesh (OR 2.93) were statistically associated with the development of a SSO (P

Original languageEnglish (US)
Pages (from-to)1658-1668
Number of pages11
JournalSurgery (United States)
Volume158
Issue number6
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

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Herniorrhaphy
Morbidity
Wounds and Injuries
Drainage
Abdominal Hernia
Seroma
Surgical Wound Infection
Cellulitis
Incidence
Abdominal Wall
Debridement
Operating Rooms
Hernia
Hematoma
Fistula
Multivariate Analysis
Logistic Models
Outcome Assessment (Health Care)
Databases
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Surgery

Cite this

Petro, C. C., Posielski, N. M., Raigani, S., Criss, C. N., Orenstein, S., & Novitsky, Y. W. (2015). Risk factors for wound morbidity after open retromuscular (sublay) hernia repair. Surgery (United States), 158(6), 1658-1668. https://doi.org/10.1016/j.surg.2015.05.003

Risk factors for wound morbidity after open retromuscular (sublay) hernia repair. / Petro, Clayton C.; Posielski, Natasza M.; Raigani, Siavash; Criss, Cory N.; Orenstein, Sean; Novitsky, Yuri W.

In: Surgery (United States), Vol. 158, No. 6, 01.12.2015, p. 1658-1668.

Research output: Contribution to journalArticle

Petro, CC, Posielski, NM, Raigani, S, Criss, CN, Orenstein, S & Novitsky, YW 2015, 'Risk factors for wound morbidity after open retromuscular (sublay) hernia repair', Surgery (United States), vol. 158, no. 6, pp. 1658-1668. https://doi.org/10.1016/j.surg.2015.05.003
Petro, Clayton C. ; Posielski, Natasza M. ; Raigani, Siavash ; Criss, Cory N. ; Orenstein, Sean ; Novitsky, Yuri W. / Risk factors for wound morbidity after open retromuscular (sublay) hernia repair. In: Surgery (United States). 2015 ; Vol. 158, No. 6. pp. 1658-1668.
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abstract = "Background Retrorectus repairs (RR) of abdominal wall hernias are growing in popularity, yet wound morbidity and predictors in this context have been characterized poorly. Models aimed at predicting wound morbidity typically do not control for technique and/or location of mesh. Our aim was to describe wound morbidity and risk factors specifically in the context of RR hernia repair. Our hypothesis was that the incidence of wound morbidity with mesh sublay would be less than predicted by a model that does not control for mesh position. Methods Consecutive RR hernia repairs with at least a 90-day follow-up were identified in our prospective database and analyzed. The primary outcome measures were the incidence of surgical-site occurrence (SSO) and surgical-site infection (SSI) via modern, standardized definitions. For predictors of SSO, statistical analysis was performed with univariate analysis, χ2, and logistic regression as well as multivariate regression. Results A total of 306 patients met the inclusion criteria. Eighty-four SSOs identified in 72 (23.5{\%}) patients included 48 (15.7{\%}) SSIs, 14 (4.6{\%}) instances of wound cellulitis, 12 (3.9{\%}) skin dehiscences, 6 (2.0{\%}) seromas, and 4 (1.3{\%}) hematomas but no instances of mesh excision or fistula formation. Treatment entailed antibiotics alone in 30 patients, 14 bedside drainage procedures, 9 radiographically assisted drainage procedures, and 10 returns to the operating room for debridement. After multivariate analysis, diabetes (OR 2.41), hernia width >20 cm (OR 2.49), and use of biologic mesh (OR 2.93) were statistically associated with the development of a SSO (P",
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AU - Orenstein, Sean

AU - Novitsky, Yuri W.

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N2 - Background Retrorectus repairs (RR) of abdominal wall hernias are growing in popularity, yet wound morbidity and predictors in this context have been characterized poorly. Models aimed at predicting wound morbidity typically do not control for technique and/or location of mesh. Our aim was to describe wound morbidity and risk factors specifically in the context of RR hernia repair. Our hypothesis was that the incidence of wound morbidity with mesh sublay would be less than predicted by a model that does not control for mesh position. Methods Consecutive RR hernia repairs with at least a 90-day follow-up were identified in our prospective database and analyzed. The primary outcome measures were the incidence of surgical-site occurrence (SSO) and surgical-site infection (SSI) via modern, standardized definitions. For predictors of SSO, statistical analysis was performed with univariate analysis, χ2, and logistic regression as well as multivariate regression. Results A total of 306 patients met the inclusion criteria. Eighty-four SSOs identified in 72 (23.5%) patients included 48 (15.7%) SSIs, 14 (4.6%) instances of wound cellulitis, 12 (3.9%) skin dehiscences, 6 (2.0%) seromas, and 4 (1.3%) hematomas but no instances of mesh excision or fistula formation. Treatment entailed antibiotics alone in 30 patients, 14 bedside drainage procedures, 9 radiographically assisted drainage procedures, and 10 returns to the operating room for debridement. After multivariate analysis, diabetes (OR 2.41), hernia width >20 cm (OR 2.49), and use of biologic mesh (OR 2.93) were statistically associated with the development of a SSO (P

AB - Background Retrorectus repairs (RR) of abdominal wall hernias are growing in popularity, yet wound morbidity and predictors in this context have been characterized poorly. Models aimed at predicting wound morbidity typically do not control for technique and/or location of mesh. Our aim was to describe wound morbidity and risk factors specifically in the context of RR hernia repair. Our hypothesis was that the incidence of wound morbidity with mesh sublay would be less than predicted by a model that does not control for mesh position. Methods Consecutive RR hernia repairs with at least a 90-day follow-up were identified in our prospective database and analyzed. The primary outcome measures were the incidence of surgical-site occurrence (SSO) and surgical-site infection (SSI) via modern, standardized definitions. For predictors of SSO, statistical analysis was performed with univariate analysis, χ2, and logistic regression as well as multivariate regression. Results A total of 306 patients met the inclusion criteria. Eighty-four SSOs identified in 72 (23.5%) patients included 48 (15.7%) SSIs, 14 (4.6%) instances of wound cellulitis, 12 (3.9%) skin dehiscences, 6 (2.0%) seromas, and 4 (1.3%) hematomas but no instances of mesh excision or fistula formation. Treatment entailed antibiotics alone in 30 patients, 14 bedside drainage procedures, 9 radiographically assisted drainage procedures, and 10 returns to the operating room for debridement. After multivariate analysis, diabetes (OR 2.41), hernia width >20 cm (OR 2.49), and use of biologic mesh (OR 2.93) were statistically associated with the development of a SSO (P

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