Surgical site infections after emergency hernia repair: substudy from the Management of Acutely Symptomatic Hernia (MASH) study
Authors: Proctor Victoria K , O’Connor Olivia M , Burns Flora A , Green Susie , Sayers Adele E , Hawkins Deborah J , Smart Neil J , Lee Matthew J ,   MASH Collaborators, Hoban D , Kattakayam A , Lunevicius R , Madzamba G , Rutka O , Hopley P , Ibrahim W , Issa M , Nair D , Reddington A , Wilson J , Ashmore D , Clarke R , Daniels A , Harrison L , Hope S , Masri A , Albendary M , Harris H , Pegna V , Sains P , Blencowe NS , Kirkham E , Rozwadowski S , Martin E , McFaul C , Maxwell V , Morgan J , Wilson T , Belgaumkar A , Elahi Z , Ma J , Maher S , Narayan P , Oyewole B , Adair R , Cowley J , Dobbins B , Grey T , Jackson A , Junejo M , Peter M , Saha A , Findlay A , Kakaniaris G , O’Grady H , Wilkins A , Yau J , Bhuvanakrishna T , Jeepalaya O , Sinclair M , Dunstan M , Gerogiannis I , Pelly T , Vance-Daniel J , Gurowich L , Hollyman M , Merker L , Amjad R , Barghash M , Dalmia S , Morris L , Tarazi M , Daniels S , Husnoo N , Johnston J , Denis E , Hirst C , Lim J , Patil S , Sarveswaran J , Scott L , Bondoqa I , Carter N , Darbyshire A , Moon M , Toh S , Banerjea A , Chia Z , Curtis J , Jackman J , Kanani T , Lewis-Lloyd C , Morton A , Ng J , Shaw M , Topham K , Kelleher R , Moug S , Pollock A , Westwood E , Donigiewicz U , Fowler GE , Hartrick O , Kushairi A , Massey L , Park L , Rajaretnam N , Walker E , Gupta S , Smith L , Williams G , Boland M , Damaskos D , Drogouti M , Wilson B , Lim M , Miu V , Onos L 
Published: January 2023

Introduction

Acutely symptomatic abdominal wall and groin hernias (ASH) are a common acute surgical presentation. There are limited data to guide decisions related to surgical repair technique and use of antibiotics, which can be driven by increased risk of surgical site infection (SSI) in this group. This study aims to report rates of SSI following ASH repair and explore the use of patient-reported outcome measure reporting in this setting.

Methods

An 18-week, UK-based, multicentre prospective cohort study (NCT04197271) recruited adults with ASH. This study reports operatively managed patients. Data on patient characteristics, inpatient management, quality of life, complications, and wound healing (Bluebelle score) were collected. Descriptive analyses were performed to estimate event rates of SSI and regression analysis explored the relationship between Bluebelle scores and SSI. The 30 and 90-day follow-up visits assessed complications and quality of life.

Results

The MASH study recruited 273 patients, of whom 218 were eligible for this study, 87.2 per cent who underwent open repair. Mesh was used in 123 patients (50.8 per cent). Pre- and postoperative antibiotics were given in 163 (67.4 per cent) and 28 (11.5 per cent) patients respectively. There were 26 reported SSIs (11.9 per cent). Increased BMI, incisional, femoral, and umbilical hernia were associated with higher rates of SSI (P = 0.006). In 238 patients, there was a difference in healthy utility values at 90 days between patients with and without SSI (P = 0.025). Also, when analysing 191 patients with Bluebelle scores, those who developed an SSI had higher Bluebelle values (P &lt; 0.001).

Conclusion

SSI is frequent in repair of acutely symptomatic hernia and correlates with BMI and site of hernia.