Evaluation of long-term surgical site occurrences in ventral hernia repair: implications of preoperative site independent MRSA infection
| Autor: | Benjamin K. Poulose, Kenneth W. Sharp, K. K. Browman, Jenny Ousley, Melissa K. Stewart, Rebeccah B. Baucom, Michael D. Holzman, Omobolanle O. Oyefule, Sharon Phillips |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Methicillin-Resistant Staphylococcus aureus medicine.medical_specialty Incisional hernia Fistula 030230 surgery 03 medical and health sciences 0302 clinical medicine Hematoma medicine Humans Surgical Wound Infection Hernia Herniorrhaphy Aged Retrospective Studies business.industry Retrospective cohort study Middle Aged Staphylococcal Infections medicine.disease Hernia Ventral Surgery Elective Surgical Procedures 030220 oncology & carcinogenesis Seroma Cellulitis Female business Abdominal surgery |
| Zdroj: | Hernia : the journal of hernias and abdominal wall surgery. 20(5) |
| ISSN: | 1248-9204 |
| Popis: | Previous work demonstrated that prior MRSA infection [MRSA(+)] is associated with 30-day surgical site infection (SSI) following ventral hernia repair (VHR). We aimed to determine the impact of MRSA(+) on long-term wound outcomes after VHR. A retrospective cohort study was performed at a tertiary center between July 11, 2005, and May 18, 2012, of patients undergoing elective VHR with class I wounds. Patients with documented preoperative MRSA infection at any site (urinary, bloodstream, SSI, etc.) were considered MRSA(+). Primary outcome was 2-year surgical site occurrence (SSO), defined as SSI, cellulitis, necrosis, nonhealing wound, seroma, hematoma, dehiscence, or fistula. SSOs were subdivided into those that required procedural intervention (SSOPI) and those that did not. Among 632 patients, 46 % were female with average age 53 ± 13 years. There were 368 SSOs in 193 patients (31 %); an SSOPI occurred in 9.8 % (n = 62). The most common SSOs were cellulitis (91/632), seroma (91/632), and serous drainage (58/632). The rate of 2-year SSO was higher with MRSA(+) compared to those without (46 vs. 29 %, p = 0.023), attributed to increased soft tissue necrosis, purulent drainage, serous drainage, cellulitis, and fistula. In multivariable analysis, MRSA(+) was not associated with 2-year SSO (HR 1.5, 95 % CI 0.91–2.55, p = 0.113); factors associated with SSO included obesity, immunosuppression, mesh repair, and operative times. This study is the first to evaluate long-term SSOs and SSOPIs after VHR, highlighting the importance of long-term follow-up. Though not independently associated with SSOs, MRSA(+) may be a marker of hernia complexity. |
| Databáze: | OpenAIRE |
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