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Wound Infection After Hernia Surgery | Risk Factors

Purpose: To identify the risk of surgical wound infection after repair of an abdominal hernia.

Description

The risk of surgical wound infection in patients undergoing abdominal hernia repair is affected by a number of risk factors, with the most important factors related to the operative procedure.


Patient population:

(1) 497 patients operated on at the University hospital in Santander, Spain for abdominal hernias

(2) 8% developed wound infection

 

Most important risk factors:

(1) duration of surgery, with risk increasing with the length of the operation

(2) infection risk of surgeon

 

Most Important Factors

Finding

Relative Risk

duration of surgery

< 1 hour

1

 

1 - 2 hours

2.9

 

> 2 hours

4.4

infection risk of surgeon

low

0.2

 

intermediate

1

 

high

2.1

 

Additional risk factors:

(1) presence of cancer

(2) morbid obesity

(3) increased serum creatinine

(4) decreased HDL cholesterol level

 

Risk Factors

Finding

Odds Ratio (95% CI)

duration of operation in hours

 

2.11 (1.12 to 4.00)

surgeon risk of infection

low

0.16 (0.03 to 0.81)

 

intermediate

1.0

 

high

1.83 (0.84 to 3.96)

presence of cancer

 

69.97 (3.55 to 1376)

morbid obesity

Quetelet index = 33 (90th percentile)

 

2.90 (0.99 to 8.50)

 

Quetelet index = 37 (97.5 percentile)

 

7.15 (1.92 to 26.6)

increased serum creatinine

"1.3 µmol/L"

4.85 (1.22 to 19.3)

decreased HDL cholesterol

< 10th percentile ("<= 0.93 nmol/L")

 

2.85 (1.09 to 7.46)

 

NOTES:

(1) The creatinine values seem suspect. The normal range for adults is 80-115 µmol/L (Tietz). One possibility is that the correct reference value should be 130 µmol/L. Alternatively they could be using 1.3 mg/dL, which equals 114.9 µmol/L ("serum creatinine concentrations above 114.9 nmol/L increased infection risk by 3.5", page 193). The error may have occurred during the translation from the Spanish.

(2) The normal range for HDL cholesterol in adults varies with age, but the lower limit of normal for males is around 0.8 mmol/L and for females is around 0.9 mmol/L (Tietz). Thus, it should be "mmol" rather than "nmol."


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Specialty

Objective

ICD-10