Skip to main content
Erschienen in: Hernia 6/2018

01.10.2018 | Invited Review

Surgical site infection: the “Achilles Heel” of all types of abdominal wall hernia reconstruction

verfasst von: D. J. Tubre, A. D. Schroeder, J. Estes, J. Eisenga, R. J. Fitzgibbons Jr.

Erschienen in: Hernia | Ausgabe 6/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Surgical site infection is the most common hospital-acquired infection in surgical patients. Recently, public health organizations have updated prevention guidelines. This review discusses surgical site infections as a complication of abdominal wall reconstruction.

Methods

The authors reviewed guidelines on prevention of surgical site infections from the Center for Disease Control and Prevention, World Health Organization, and National Institute for Health and Care Excellence and put them into context with the relevant abdominal wall reconstruction literature. This was the subject of the Nyhus–Wantz lecture given at The International Hernia Congress on March 14, 2018 in Miami, FL and is summarized here.

Results

Routine use of preoperative antibiotics in prosthetic groin hernia repair is not supported by the available literature. High-quality data on antibiotic prophylaxis in ventral (both primary and incisional) hernia repair is lacking, but it is widely utilized and may reduce SSIs. Recommended preventative strategies discussed in this manuscript include: treatment of remote site infections, perioperative normothermia and normoglycemia, avoidance of hypoxemia, antiseptic preparation of surgical team hands and patient skin, treatment of obesity, smoking cessation, correction of malnutrition, and physical conditioning.

Conclusion

Surgical site infections lead to significant morbidity and mortality, hernia recurrences, prolonged hospital stay, and increased hospital costs. This makes surgical site infections the “Achilles Heel” of abdominal wall reconstruction. Strict adherence to standardized guidelines and preoperative optimization of patients’ risk profiles are crucial to decrease the incidence of surgical site infections.
Literatur
10.
Zurück zum Zitat Surgeons AC (2016) American college of surgeons national surgical quality improvement program (ACS NSQIP). American College of Surgeons, pp 1–2 Surgeons AC (2016) American college of surgeons national surgical quality improvement program (ACS NSQIP). American College of Surgeons, pp 1–2
16.
Zurück zum Zitat Hidron AI, Edwards JR, Patel J et al (2008) NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol 29:996–1011. https://doi.org/10.1086/591861 CrossRefPubMed Hidron AI, Edwards JR, Patel J et al (2008) NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol 29:996–1011. https://​doi.​org/​10.​1086/​591861 CrossRefPubMed
31.
Zurück zum Zitat White TJ, Santos MC, Thompson JS (1998) Factors affecting wound complications in repair of ventral hernias. Am Surg 64:276–280PubMed White TJ, Santos MC, Thompson JS (1998) Factors affecting wound complications in repair of ventral hernias. Am Surg 64:276–280PubMed
38.
41.
Zurück zum Zitat Surv Surveillance report 2017-Surgical site eillance report 2017-Surgical site infections: pre infections: prevention and treatment ention and treatment (2008) NICE guideline CG74 (2008) NICE guideline CG74 surveillance report contents Contents (2017) Surv Surveillance report 2017-Surgical site eillance report 2017-Surgical site infections: pre infections: prevention and treatment ention and treatment (2008) NICE guideline CG74 (2008) NICE guideline CG74 surveillance report contents Contents (2017)
46.
Zurück zum Zitat Rios A, Rodriguez JM, Munitiz V et al (2001) Antibiotic prophylaxis in incisional hernia repair using a prosthesis. Hernia 5:148–152CrossRefPubMed Rios A, Rodriguez JM, Munitiz V et al (2001) Antibiotic prophylaxis in incisional hernia repair using a prosthesis. Hernia 5:148–152CrossRefPubMed
47.
Zurück zum Zitat Abramov D, Jeroukhimov I, Yinnon AM et al (1996) Antibiotic prophylaxis in umbilical and incisional hernia repair: a prospective randomised study. Eur J Surg 162:945–948; discussion 949PubMed Abramov D, Jeroukhimov I, Yinnon AM et al (1996) Antibiotic prophylaxis in umbilical and incisional hernia repair: a prospective randomised study. Eur J Surg 162:945–948; discussion 949PubMed
48.
Zurück zum Zitat Alexander JW, Fischer JE, Boyajian M et al (1983) The influence of hair-removal methods on wound infections. Arch Surg 118:347–352CrossRefPubMed Alexander JW, Fischer JE, Boyajian M et al (1983) The influence of hair-removal methods on wound infections. Arch Surg 118:347–352CrossRefPubMed
54.
Zurück zum Zitat Hopf HW, Holm J (2008) Hyperoxia and infection. Best Pract Res Clin Anaesthesiol 22:553–569CrossRefPubMed Hopf HW, Holm J (2008) Hyperoxia and infection. Best Pract Res Clin Anaesthesiol 22:553–569CrossRefPubMed
55.
Zurück zum Zitat Hopf HW, Hunt TK, West JM et al (1997) Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg 132:997–1004 (discussion 1005)CrossRefPubMed Hopf HW, Hunt TK, West JM et al (1997) Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg 132:997–1004 (discussion 1005)CrossRefPubMed
60.
Zurück zum Zitat Garibaldi RA (1988) Prevention of intraoperative wound contamination with chlorhexidine shower and scrub. J Hosp Infect 11(Suppl B):5–9CrossRefPubMed Garibaldi RA (1988) Prevention of intraoperative wound contamination with chlorhexidine shower and scrub. J Hosp Infect 11(Suppl B):5–9CrossRefPubMed
61.
Zurück zum Zitat Cruse PJ, Foord R (1973) A five-year prospective study of 23,649 surgical wounds. Arch Surg 107:206–210CrossRefPubMed Cruse PJ, Foord R (1973) A five-year prospective study of 23,649 surgical wounds. Arch Surg 107:206–210CrossRefPubMed
64.
Zurück zum Zitat Hardin WNR (1997) Handwashing and patient skin preparation. In: Malangoni M (ed) Critical issues in operating room managemene. Lippincott-Raven, Philadelphia, pp 133–149 Hardin WNR (1997) Handwashing and patient skin preparation. In: Malangoni M (ed) Critical issues in operating room managemene. Lippincott-Raven, Philadelphia, pp 133–149
65.
Zurück zum Zitat Larson EL (1995) APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 23:251–269CrossRefPubMed Larson EL (1995) APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 23:251–269CrossRefPubMed
67.
Zurück zum Zitat Boyce JM, Pittet D (2002) Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Prof. MMWR recommendations reports. Morb Mortal Wkly Rep 51:1–45 (quiz CE1–4) Boyce JM, Pittet D (2002) Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Prof. MMWR recommendations reports. Morb Mortal Wkly Rep 51:1–45 (quiz CE1–4)
Metadaten
Titel
Surgical site infection: the “Achilles Heel” of all types of abdominal wall hernia reconstruction
verfasst von
D. J. Tubre
A. D. Schroeder
J. Estes
J. Eisenga
R. J. Fitzgibbons Jr.
Publikationsdatum
01.10.2018
Verlag
Springer Paris
Erschienen in
Hernia / Ausgabe 6/2018
Print ISSN: 1265-4906
Elektronische ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-018-1826-9

Weitere Artikel der Ausgabe 6/2018

Hernia 6/2018 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.