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Predictors Of Wound Infection In Ventral Hernia Repair

Abdominal wall hernias are one of the most common conditions treated by general surgeons, with more than 100,000 repairs// performed annually. Although ventral hernia repair (VHR) is a common operation, recurrences and complications remain a vexing problem. Wound infection has been identified as a consistent risk factor for recurrence after VHR.

A recent study, which appears in the November issue of The American Journal of Surgery was designed with the aim to identify predictors of postoperative wound infection in subjects undergoing VHR in a retrospective multicenter study of ventral hernia outcomes. The study examines patient- and procedure-specific variables associated with wound infection, and specifically focuses on the effect of mesh placement at VHR on postoperative wound complications.

For the study, a cohort of subjects undergoing VHR from 13 regional Veterans Health Administration (VHA) sites was identified. Patient-specific risk variables were obtained from National Surgical Quality Improvement Program (NSQIP) data. Operative variables were obtained from physician-abstracted operative notes. Univariate and multivariable logistic regression analysis was used to model predictors of postoperative wound infection.

A total of 1505 VHR cases were used for analysis; wound infection occurred in 5% (n = 74). Best-fit logistic regression models demonstrated that steroid use, smoking, prolonged operative time, and use of absorbable mesh, acting as a surrogate marker for a more complex procedure, were significant independent predictors of wound infection.

The results demonstrated that chronic steroid use, current smoking, prolonged operative time, and use of absorbable mesh (likely a marker for more complex intraoperative variables) were significant predictors of postoperative wound infection in VHR.

The only modifiable risk factor identified was current smoking. Smoking cessation prior to elective hernia repair
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