Surgical site infection following elective mesh repair of inguinal hernia: an analysis of risk factors

Abstract Background: Surgical site infection (SSI) is a complication of mesh repair of inguinal hernia (IH) with an increase in length of stay and costs. We investigated both controllable and non-controllable risk factors for SSI following elective mesh repair of IH. Methods: A retrospective analysis was conducted of 1177 adult patients who underwent elective mesh repair of IH (not receiving antibiotic prophylaxis) from January 2010 to September 2019. Demographics, surgical variables and laboratory data were extracted from the electronic medical records. Receiver operating characteristic (ROC) analysis was performed to determine the optimal threshold of continuous variables. Independent risk factors for SSI were identified by univariate and multivariate analyses. Results: In total, 647 open and 530 laparoscopic IH repairs were included. The overall SSI rate within 30 days after surgery was 3.2% (39/1342 hernias) in the absence of antibiotic prophylaxis. Both the preoperative neutrophil‐lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were negatively correlated with the postoperative period of SSI (r = -0.368, P = 0.021; r = -0.334, P = 0.038, respectively). On multivariate analyses, body mass index (BMI) > 24.6 kg/m 2 (odds ratio [OR], 1.152; 95% confidence interval [CI], 1.041-1.275), current smoker (OR, 4.226; 95% CI, 1.222-14.611), preoperative NLR > 1.97 (OR, 3.670; 95% CI, 1.675-8.041), and open approach (OR, 4.866; 95% CI, 1.877-12.618) were significantly related to postoperative SSI. Conclusion: The controllable risk factors (elevated BMI, current smoker) found out here may help to identify patients at high-risk of SSI, allowing targeted preventive measures. Preoperative NLR > 1.97 is a previous unrecorded predictor for SSI following elective mesh repair of IH. Further study is needed to ascertain the magnitude of their effect.