Postoperative infection in eventrorrhaphy: Related factors
Infección postoperatoria en eventrorrafias: Factores relacionados
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Abstract
Introduction: incisional or ventral hernias develop in 1 to 16% of patients after laparotomy. Consequently, the performance of incisional herniorrhaphies has become very frequent in surgery services. The National Nosocomial Infection Surveillance System NNISS, reports surgical site infection (SSI) as the third most frequent nosocomial infection among hospitalized patients, with a prevalence rate of 14 to 16%.' Multiple factors influence the development of SSIs following an incisional herniorrhaphy and SSI is identified as a recurrence risk factor. Objective: to describe the frequency of SSIs, and identify related factors for SSI, in patients who underwent an incisional herniorrhaphy. Methodology: a descriptive cross-sectional study conducted between July 1, 2004 and July 1, 2006 in the San José Hospital analyzed demographic, surgical, incisional-hernia-specific and postoperative-specific variables, as well as infection-risk scales. Results: of the 132 patients studied, 58.3% (77) were females and 41.6% (55) males; the mean age was 50 years. The overall frequency of SSIs was 9% (12); superficial wound SSI was identified in 10 cases (7.5%) and deep wound SSI in 2 cases (1.5%). Antecedents of patients with SSI included diabetes mellitus 25%, coronary artery disease and COPD in 8.3% and 33% had a history of cigarette smoking. In patients without SSI the latter were 5%, 2.5%, 5.8% and 9% respectively. The mean time of surgery procedure was 115 minutes in patients with SSI and 86 minutes in patients without SSI. Four patients (33 %) with SSI required an emergency surgery procedure due to incarceration. No SSI was documented in two patients who required intestinal resection. NNISS and SENIC scores for the risk of infection in these two patients were 3 and 4 respectively. Conclusions: the overall frequency of SSIs and risk factors described in this study are similar to those reported in published medical literature. Further prospective studies with adequate follow-up are required to identify risk factors for SSIs. Monitoring of the behavior of SSIs secondary to incisional herniorrhaphy must also be conducted in the hospital setting. Abbreviations: ISO, infection of the operative site; COPD, chronic obstructive pulmonary disease; NNISS, national nosocomial infection surveillonce systems; IPO, postoperative infection.
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2. Vidal Sans J, Planas Guasch J, Moreno Amezcua JM, Janer Torné J, Palacín Casal JM, Mora Ruiz F, et al. Tratamiento quirúrgico de las eventraciones: análisis de 1.235 casos intervenidos en un período de 20 años. Cir Esp. 1993; 54:126-31.
3. Martínez Gómez AD, García Marcilla JA, Morcillo Ródenas MA, Zaragoza Zaragoza C, Martínez Ripoll JF, Navarro Gómez R, et al. Resultados de las prótesis en las eventraciones moderadas y grandes. Cir Esp. 1997; 62:32-7.
4. Larson GM, Vandertoll DJ. Approaches to repair of ventral hernia and full-thickness losses of the abdominal wall. Surg Clin North Am. 1984 Apr;64(2):335-49.
5. Mudge M, Hughes LE.Incisional hernia: a 10 year prospective study of incidence and attitudes.Br J Surg. 1985 Jan;72(1):70-1.
6. Yahchouchy-Chouillard E, Aura T, Picone O, Etienne JC, Fingerhut A. Incisional hernias. I. Related risk factors. Dig Surg. 2003;20(1):3-9.
7. Chevrel JP. [The treatment of large midline incisional hernias by "overcoat" plasty and prothesis (author's transl)]Nouv Presse Med. 1979 Feb 24;8(9):695-6.
8. Rives J, Pire JC, Palot JP, Flament JB. Surgery of the abdominal wall: Major incisional hernias. J Surg Res. 1987; 115:85-92.
9. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988 Jun;16(3):128-40.
10. Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, Banerjee SN, Edwards JR, Tolson JS, Henderson TS, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med. 1991 Sep 16;91(3B):152S-157S.
11. Dunne JR, Malone DL, Tracy JK, Napolitano LM. Abdominal wall hernias: risk factors for infection and resource utilization. J Surg Res. 2003 May 1;111(1):78-84.
12. White TJ, Santos MC, Thompson JS. Factors affecting wound complications in repair of ventral hernias. Am Surg. 1998 Mar;64(3):276-80.
13. Balén EM, Díez-Caballero A, Hernández-Lizoáin JL, Pardo F, Torramadé JR, Regueira FM, Cienfuegos JA. Repair of ventral hernias with expanded polytetrafluoroethylene patch.Br J Surg. 1998 Oct;85(10):1415-8.
14. Leber GE, Garb JL, Alexander AI, Reed WP. Longterm complications associated with prosthetic repair of incisional hernias. Arch Surg. 1998 Apr;133(4):378-82.
15. Cassar K, Munro A. Surgical treatment of incisional hernia. Br J Surg. 2002 May;89(5):534-45.
16. Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000 Aug 10;343(6):392-8.
17. Medina M, Sillero M, Martínez-Gallego G, Delgado Rodríguez M. Risk factors of surgical wound infection in patients undergoing herniorrhaphy. Eur J Surg. 1997 Mar;163(3):191-8.
18. Promis G, Nacrur R. Infección quirúrgica en heridas limpias. Rev Chil Cir. 1990; 42:51-4.
19. Cruse PJ, Foord R.The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am. 1980 Feb;60(1):27-40.
20. Anaya D, editor. Herida e Infección quirúrgica. Bogotá: Federación Latinoamericana de Cirugía; 1999.
21. Crabtree TD, Codd JE, Fraser VJ, Bailey MS, Olsen MA, Damiano RJ Sr. Multivariate analysis of risk factors for deep and superficial stemal infection after coronary artery bypass grafting at a tertiary care medical center. Semin Thorac Cardiovasc Surg. 2004 Spring;16(1):53-61.
22. Sorensen LT, Hemmingsen U, Kallehave F, Wille-Jorgensen P, Kjaergaard 5, Moller LN, Jorgensen T. Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg. 2005 Apr;241(4):654-8.
23. Y1o5nen K, Biancari F, Leo E, Rainio P, Salmela E, Lahtinen J, Satta J, Pokela R, Lepojárvi M, Juvonen T. Predictors of development of anastomotic femoral pseudoaneurysms after aortobifemoral reconstruction for abdominal aortic aneurysm. Am J Surg. 2004 Jan;187(1):83-7.
24. Stoppa RE, Warlaumont CR, Verhaeghe PJ, Romero ER, M'Balla-N'Di CJ.Prosthetic repair in the treatment of groin hernias.Int Surg. 1986 Jul-Sep;71(3):154-8.
25. Fry DE, Osler T. Abdominal wall considerations and complications in reoperative surgery. Surg Clin North Am. 1991 Feb;71(1):1-11.
26. Elorza Orúe JL, Palomar de Luis M, Elósegui Al. La malla de politetrafluoroetileno en la reparación de las grandes eventraciones. Cir Esp. 1992;51:275-7.
27. Langer S, Christiansen J. Long term results alter incisional hernia repair. Acta Chir Scand. 1985;151(3):217-9.
28. Bailey IS, Karran SE, Toyn K, Brough P, Ranaboldo C, Karran SJ.Community surveillance of complications after hernia surgery. BMJ. 1992 Feb 22;304(6825):469-71.
29. Promis G, Villablanca L. Infección de la herida quirúrgica del Servicio de Cirugía del Hospital Félix Bulnes Cerda. Rev Chil Cir. 2000;52: 593-600.
30. Taylor EW, Byrne DJ, Leaper DJ, Karran SS, Browne MK, Mitchell KJ.Antibiotic prophylaxis and open groin hernia repair.World J Surg. 1997 Oct;21(8):811-4; discussion 814-5.
31. Taylor EW, Duffy K, Lee K, Hill R, Noone A, Macintyre I, King PM, O'Dwyer PJ. Surgical site infection after groin hernia repair. Br J Surg. 2004 Jan;91(1):105-11.