TY - JOUR
T1 - Evaluation of long-term surgical site occurrences in ventral hernia repair
T2 - implications of preoperative site independent MRSA infection
AU - Baucom, R. B.
AU - Ousley, J.
AU - Oyefule, O. O.
AU - Stewart, M. K.
AU - Phillips, S. E.
AU - Browman, K. K.
AU - Sharp, K. W.
AU - Holzman, M. D.
AU - Poulose, B. K.
N1 - Funding Information:
Dr. Poulose has received grant support for unrelated research from Bard-Davol, and he has a consultant relationship with Ariste Medical and Pfizer. Dr. Kummerow Broman is supported by the Office of Academic Affiliations, Department of Veterans Affairs, VA National Quality Scholars Program and used facilities at VA Tennessee Valley Healthcare System, Nashville, Tennessee. The remaining authors report no conflicts of interest or funding sources.
Publisher Copyright:
© 2016, Springer-Verlag France.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Purpose: Previous work demonstrated that prior MRSA infection [MRSA(+)] is associated with 30-day surgical site infection (SSI) following ventral hernia repair (VHR). We aimed to determine the impact of MRSA(+) on long-term wound outcomes after VHR. Participants: A retrospective cohort study was performed at a tertiary center between July 11, 2005, and May 18, 2012, of patients undergoing elective VHR with class I wounds. Patients with documented preoperative MRSA infection at any site (urinary, bloodstream, SSI, etc.) were considered MRSA(+). Primary outcome was 2-year surgical site occurrence (SSO), defined as SSI, cellulitis, necrosis, nonhealing wound, seroma, hematoma, dehiscence, or fistula. SSOs were subdivided into those that required procedural intervention (SSOPI) and those that did not. Results: Among 632 patients, 46 % were female with average age 53 ± 13 years. There were 368 SSOs in 193 patients (31 %); an SSOPI occurred in 9.8 % (n = 62). The most common SSOs were cellulitis (91/632), seroma (91/632), and serous drainage (58/632). The rate of 2-year SSO was higher with MRSA(+) compared to those without (46 vs. 29 %, p = 0.023), attributed to increased soft tissue necrosis, purulent drainage, serous drainage, cellulitis, and fistula. In multivariable analysis, MRSA(+) was not associated with 2-year SSO (HR 1.5, 95 % CI 0.91–2.55, p = 0.113); factors associated with SSO included obesity, immunosuppression, mesh repair, and operative times. Conclusions: This study is the first to evaluate long-term SSOs and SSOPIs after VHR, highlighting the importance of long-term follow-up. Though not independently associated with SSOs, MRSA(+) may be a marker of hernia complexity.
AB - Purpose: Previous work demonstrated that prior MRSA infection [MRSA(+)] is associated with 30-day surgical site infection (SSI) following ventral hernia repair (VHR). We aimed to determine the impact of MRSA(+) on long-term wound outcomes after VHR. Participants: A retrospective cohort study was performed at a tertiary center between July 11, 2005, and May 18, 2012, of patients undergoing elective VHR with class I wounds. Patients with documented preoperative MRSA infection at any site (urinary, bloodstream, SSI, etc.) were considered MRSA(+). Primary outcome was 2-year surgical site occurrence (SSO), defined as SSI, cellulitis, necrosis, nonhealing wound, seroma, hematoma, dehiscence, or fistula. SSOs were subdivided into those that required procedural intervention (SSOPI) and those that did not. Results: Among 632 patients, 46 % were female with average age 53 ± 13 years. There were 368 SSOs in 193 patients (31 %); an SSOPI occurred in 9.8 % (n = 62). The most common SSOs were cellulitis (91/632), seroma (91/632), and serous drainage (58/632). The rate of 2-year SSO was higher with MRSA(+) compared to those without (46 vs. 29 %, p = 0.023), attributed to increased soft tissue necrosis, purulent drainage, serous drainage, cellulitis, and fistula. In multivariable analysis, MRSA(+) was not associated with 2-year SSO (HR 1.5, 95 % CI 0.91–2.55, p = 0.113); factors associated with SSO included obesity, immunosuppression, mesh repair, and operative times. Conclusions: This study is the first to evaluate long-term SSOs and SSOPIs after VHR, highlighting the importance of long-term follow-up. Though not independently associated with SSOs, MRSA(+) may be a marker of hernia complexity.
KW - Incisional hernia
KW - Methicillin resistant Staphylococcus aureus (MRSA)
KW - Surgical site occurrence (SSO)
KW - Ventral hernia
UR - http://www.scopus.com/inward/record.url?scp=84981234349&partnerID=8YFLogxK
U2 - 10.1007/s10029-016-1523-5
DO - 10.1007/s10029-016-1523-5
M3 - Article
C2 - 27502493
AN - SCOPUS:84981234349
SN - 1265-4906
VL - 20
SP - 701
EP - 710
JO - Hernia
JF - Hernia
IS - 5
ER -