Introduction: Despite being one of the most commonly performed general surgery procedures, surgical site infection (SSI) is still seen in primary, elective, open inguinal hernia repair. Studies have reported a wide range of infection rates, yet predictive risk factors have not been definitely identified leading to variability and controversy in the use of pre-operative antibiotics. In this study, the authors seek to identify factors predictive of SSI development in a large cohort of patients undergoing initial unilateral open inguinal repair.
Methods: The American College of Surgery National Surgical Quality Improvement Program (ACS NSQIP) personal use file (PUF) database was queried for initial, open, reducible inguinal hernia repair cases in adults with clean surgical sites performed from 2012 to 2015 (CPT 49,505 and class one wound). Patient data were analyzed using univariate and multivariate analysis to identify factors predictive of surgical site infection.
Results: 57,951 cases were identified. 90.8% were men with an average age of 58.2 years and a median operative time of 53.0 min. Of all variables evaluated with univariate logistic regression, 17 demonstrated an association with surgical site infection. Performing multiple logistic regression on those 17 variables yielded 3 factors independently associated with surgical site infection: diabetes (OR 2.017, 95% CI 1.012-4.023), BMI ≥ 35 kg/m2 (OR 2.587, 95% CI 1.123-5.964), and current smoking (OR 2.071, 95% CI 1.126-3.811).
Conclusion: Diabetes, BMI ≥ 35 kg/m2, and current smoking are significantly associated with an increased odds surgical site infection after initial, open, reducible inguinal hernia repair in adults with clean surgical sites.
Keywords: Hernia; NSQIP; SSI.