Impact of Surgical Site Infections on Elective Incisional Hernia Surgery: A Prospective Study

Background: Although incisional hernia repair is classified as a clean surgery, it still has a high incidence of surgical site infection (SSI) (0.7%-26.6%). The presence of an SSI could increase early recurrence rates after incisional hernia repair. Patients and Methods: Patients undergoing elective incisional hernia repair with no bowel contamination between January and December 2015 were assessed prospectively. Demographic and surgical data, local post-operative complications, and one-year recurrence rates in patients with and without SSI were compared. The management of SSI was determined. Results: Patients with SSI (16/101) showed more prolonged surgical procedures (9139 vs. 63 +/- 30min, p=0.012), more post-operative sero-hematomas (38% vs. 8%, p=0.001), and a higher one-year recurrence rate (19% vs. 4%, p=0.047). Multivariable analysis revealed the only identified risk factor for SSI to be post-operative sero-hematomas (p=0.042; odds ratio [OR]=4.17 [1.05-16.54]). Patients who developed an SSI required antibiotic agents and daily treatment from one to five months. One of these required the removal of the mesh. Conclusions: Surgical site infection rates are high for incisional hernia surgery (16%), and associated with local complications. Surgical site infection requires long-term treatments and leads to a higher one-year recurrence rate.