Risks and Prevention of Surgical Site Infection After Hernia Mesh Repair and the Predictive Utility of ACS-NSQIP.
Robert Beaumont WilsonYasser FarooquePublished in: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (2022)
The three major modifiable patient comorbidities significantly associated with postoperative surgical site infection in hernia surgery are obesity, tobacco smoking and diabetes mellitus. Preoperative optimization includes weight loss, cessation of smoking, and control of diabetes. Intraoperative interventions relate, in particular, to the control of fomite mediated transmission in the operating theatre and prevention of mesh contamination with S. aureus CFUs. Risk management strategies should also target the niche ecological conditions which enable bacterial survival and subsequent biofilm formation on an implanted mesh. Outcomes of mesh infection after hernia surgery are closely related to mesh type and porosity, patient smoking status, presence of MRSA, bacterial adhesion and biofilm production. The use of suction drains and the timing of drain removal are controversial and discussed in detail. Finally, the utility of the ACS-NSQIP Surgical Risk Calculator in predicting complications and outcomes in individual patients and the importance of quality improvement initiatives in surgical units are emphasized.
Keyphrases
- surgical site infection
- quality improvement
- biofilm formation
- staphylococcus aureus
- weight loss
- pseudomonas aeruginosa
- candida albicans
- smoking cessation
- type diabetes
- glycemic control
- patients undergoing
- acute coronary syndrome
- patient safety
- escherichia coli
- end stage renal disease
- human health
- case report
- bariatric surgery
- minimally invasive
- metabolic syndrome
- cardiovascular disease
- newly diagnosed
- roux en y gastric bypass
- climate change
- risk assessment
- prognostic factors
- risk factors
- ejection fraction
- drinking water
- chronic kidney disease
- percutaneous coronary intervention
- skeletal muscle
- gastric bypass
- weight gain
- patient reported outcomes
- cystic fibrosis
- coronary artery disease
- health risk
- drug induced