Surgical Site Infections Following Ventral Hernia Repair: Does Operative Approach Matter?

Sara A Hennessy, MD2, Tjasa Hranjec, MD, MS1, Peter T Hallowell, MD2, Bruce D Schirmer, MD2. 2University of Virginia, 1University of Southwestern Texas

Introduction: Approximately 3-13% of patients with abdominal surgery develop a ventral hernia and over 350,000 ventral hernias are repaired annually. A surgical site infection (SSI) after ventral hernia repair (VHR), either open or laparoscopic, is a highly morbid complication associated with increasing health care costs, hernia recurrences, mesh infections and their complications. With the many advances in preoperative, operative and post-operative care the current incidence of surgical sites infections after laparoscopic VHR is unclear. We hypothesized that the incidence of surgical site infections is significantly reduced with a laparoscopic ventral hernia repair.

Methods and Procedures: The prospectively collected American College of Surgeons’ National Surgical Quality Improvement Program database was retrospectively reviewed for all VHRs with mesh between January 2011 and May 2014 at a single institution. Patients who underwent laparoscopic VHR and open VHR were compared by univariate analysis using Wilcoxon rank sum, Chi-square, and Fisher’s exact tests where appropriate. A multivariate logistic regression was performed to identify independent predictors of all surgical site infections (superficial, deep and organ space SSI).

Results: Of 591 patients, 338 (57%) had a laparoscopic VHR and 253 (43%) had an open VHR. Patients undergoing a laparoscopic VHR had a significantly lower incidence of all surgical site infections at 30-day follow up, including superficial SSI, deep SSI and organ space SSI (Table 1.) There was no significant difference in 30-day re-admission or mortality between laparoscopic and open VHRs. Patients undergoing open VHR had a higher incidence of post-operative bleeding requiring transfusion as compared to laparoscopic VHR (2.7% vs 0.2%, p < 0.001). On multivariate analysis (C statistic = 0.822) a laparoscopic ventral hernia repair was protective against all surgical site infections (OR 0.18, p=0.01).

Conclusion: A laparoscopic VHR is independently associated with a lower risk of all surgical site infections with a current incidence of 1.8%. A laparoscopic repair should be performed in all eligible cases to decrease overall morbidity and healthcare costs.


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