Analysis of risk factors for postoperative infection of abdominal wall hernia

doi:10.3877/cma.j.issn.1674-392X.2024.06.019

Abstract

Abstract:

Objective

To investigate the risk factors for postoperative infection in patients undergoing abdominal wall hernia surgery.

Methods

A retrospective analysis was conducted on the clinical data of 296 patients who underwent abdominal wall hernia surgery at Funan County People's Hospital from January 2020 to January 2023.Based on whether postoperative infection occurred, patients were divided into an infection group (36 cases) and a non-infection group (260 cases).Univariate analysis and logistic regression analysis were used to identify risk factors for postoperative infection.

Results

A total of 296 patients who underwent abdominal wall hernia surgery were included, with 36 patients experiencing postoperative infections, resulting in an infection rate of 12.16% (36/296).There were no statistically significant differences between the infection and non-infection groups in terms of sex, body mass index, hypertension, alcohol consumption, smoking, operation duration, bowel necrosis, history of abdominal wall hernia, history of abdominal surgery, postoperative day 1 albumin levels, procalcitonin(PCT), or the neutrophil-to-lymphocyte ratio (NLR) (P＞0.05).However, significant differences were observed between the groups regarding age, wound infection, diabetes mellitus, bowel necrosis, reoperation,postoperative day 1 C-reactive protein (CRP), and white blood cell count (P＜0.05).Binary logistic regression analysis identified age ≥65 years (OR=3.224), wound infection (OR=3.517), diabetes mellitus(OR=3.187), bowel necrosis (OR=4.046), reoperation (OR=3.543), postoperative day 1 CRP (OR=3.701),and white blood cell count (OR=4.061) as significant risk factors for postoperative infection (P＜0.05).

Conclusion

Age, wound infection, diabetes mellitus, bowel necrosis, reoperation, postoperative day 1 CRP, and white blood cell count are risk factors for postoperative infection in patients undergoing abdominal wall hernia surgery.Targeted interventions based on these risk factors can effectively reduce the incidence of postoperative infections.

Key words: abdominal wall hernia, postoperative infection, risk factors

Chuang Yang, Xue Ma. Analysis of risk factors for postoperative infection of abdominal wall hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 693-696.

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Figures/Tables 3

项目		感染组(36例)	未感染组(260例)	χ²值	P值
年龄[例(%)]				9.867	0.002
	＞65岁	23(63.89)	95(36.54)
	≤65岁	13(36.11)	165(63.46)
性别[例(%)]				1.332	0.249
	男性	25(69.44)	203(78.08)
	女性	11(30.56)	57(21.92)
伤口感染[例(%)]				9.446	0.002
	是	24(66.67)	103(39.62)
	否	12(33.33)	157(60.38)
BMI[例(%)]				3.653	0.056
	＞25 kg/m²	20(55.56)	101(38.85)
	≤25 kg/m²	16(44.44)	159(61.15)
糖尿病[例(%)]				9.438	0.002
	有	22(61.11)	90(34.62)
	无	14(38.89)	170(65.38)
高血压[例(%)]				1.442	0.230
	有	10(27.78)	99(38.08)
	无	26(72.22)	161(61.92)
饮酒[例(%)]				0.312	0.577
	有	19(52.78)	150(57.69)
	无	17(47.22)	110(42.31)
吸烟[例(%)]				0.540	0.463
	有	20(55.56)	161(61.92)
	无	16(44.44)	99(38.08)
手术时长[例(%)]				3.802	0.051
	＞2 h	21(58.33)	107(41.15)
	≤2 h	15(41.67)	153(58.85)
肠坏死[例(%)]				10.032	0.002
	是	24(66.67)	101(38.85)
	否	12(33.33)	159(61.15)
二次手术[例(%)]				9.749	0.002
	是	22(61.11)	89(34.23)
	否	14(38.89)	171(65.77)
腹壁疝病史[例(%)]				0.338	0.561
	有	9(25.00)	54(20.77)
	无	27(75.00)	206(79.23)
腹部手术史[例(%)]				0.970	0.325
	＞3 d	11(30.56)	60(23.08)
	≤3 d	25(69.44)	200(76.92)
术后1 d CRP[例(%)]				9.867	0.002
	＞11 mg/L	23(63.89)	95(36.54)
	≤11 mg/L	13(36.11)	165(63.46)
白细胞计数[例(%)]				9.162	0.002
	＞20×10⁹/L	24(66.67)	104(40.00)
	≤20×10⁹/L	12(33.33)	156(60.00)
术后1 d白蛋白(g/L, $\overset{ˉ}{x}$ ±s)		44.01±4.75	42.48±4.46	1.194	0.057
术后1 d PCT(ng/ml, $\overset{ˉ}{x}$ ±s)		1.25±0.41	1.128±0.39	1.863	0.063
术后1 d NLR(g/dl, $\overset{ˉ}{x}$ ±s)		8.44±2.06	7.95±1.52	1.729	0.085

项目		感染组(36例)	未感染组(260例)	χ²值	P值
年龄[例(%)]				9.867	0.002
	＞65岁	23(63.89)	95(36.54)
	≤65岁	13(36.11)	165(63.46)
性别[例(%)]				1.332	0.249
	男性	25(69.44)	203(78.08)
	女性	11(30.56)	57(21.92)
伤口感染[例(%)]				9.446	0.002
	是	24(66.67)	103(39.62)
	否	12(33.33)	157(60.38)
BMI[例(%)]				3.653	0.056
	＞25 kg/m²	20(55.56)	101(38.85)
	≤25 kg/m²	16(44.44)	159(61.15)
糖尿病[例(%)]				9.438	0.002
	有	22(61.11)	90(34.62)
	无	14(38.89)	170(65.38)
高血压[例(%)]				1.442	0.230
	有	10(27.78)	99(38.08)
	无	26(72.22)	161(61.92)
饮酒[例(%)]				0.312	0.577
	有	19(52.78)	150(57.69)
	无	17(47.22)	110(42.31)
吸烟[例(%)]				0.540	0.463
	有	20(55.56)	161(61.92)
	无	16(44.44)	99(38.08)
手术时长[例(%)]				3.802	0.051
	＞2 h	21(58.33)	107(41.15)
	≤2 h	15(41.67)	153(58.85)
肠坏死[例(%)]				10.032	0.002
	是	24(66.67)	101(38.85)
	否	12(33.33)	159(61.15)
二次手术[例(%)]				9.749	0.002
	是	22(61.11)	89(34.23)
	否	14(38.89)	171(65.77)
腹壁疝病史[例(%)]				0.338	0.561
	有	9(25.00)	54(20.77)
	无	27(75.00)	206(79.23)
腹部手术史[例(%)]				0.970	0.325
	＞3 d	11(30.56)	60(23.08)
	≤3 d	25(69.44)	200(76.92)
术后1 d CRP[例(%)]				9.867	0.002
	＞11 mg/L	23(63.89)	95(36.54)
	≤11 mg/L	13(36.11)	165(63.46)
白细胞计数[例(%)]				9.162	0.002
	＞20×10⁹/L	24(66.67)	104(40.00)
	≤20×10⁹/L	12(33.33)	156(60.00)
术后1 d白蛋白(g/L, $\overset{ˉ}{x}$ ±s)		44.01±4.75	42.48±4.46	1.194	0.057
术后1 d PCT(ng/ml, $\overset{ˉ}{x}$ ±s)		1.25±0.41	1.128±0.39	1.863	0.063
术后1 d NLR(g/dl, $\overset{ˉ}{x}$ ±s)		8.44±2.06	7.95±1.52	1.729	0.085

变量	赋值方式
年龄	＞65岁=—1”；≤65 岁=—0”
伤口感染	是=—1”；否=—0”
糖尿病	是=—1”；否=—0”
肠坏死	是=—1”；否=—0”
二次手术	是=—1”；否=—0”
术后1 d C反应蛋白	＞20×10⁹/L=—1”；≤20×109/L=—0”
白细胞计数	＞11 mg/L=—1”；≤11 mg/L=—0”

因素	回归系数	标准误	Wald值	P值	OR值	95%CI
年龄	1.171	0.433	7.295	0.007	3.224	1.379～7.539
伤口感染	1.258	0.448	7.887	0.005	3.517	1.462～8.458
糖尿病	1.159	0.431	7.243	0.007	3.187	1.370～7.415
肠坏死	1.398	0.439	10.140	0.001	4.046	1.712～9.564
二次手术	1.265	0.435	8.470	0.004	3.543	1.512～8.306
术后1 d CRP	1.309	0.435	9.043	0.003	3.701	1.577～8.686
白细胞计数	1.402	0.441	10.097	0.001	4.061	1.711～9.640
常数	-6.534	0.833	61.596	0.000	0.001

References 21

[1]	陈璐, 张卓, 李鹏洲, 等.腹腔镜下腹壁疝腹膜外补片修补术与腹腔内补片修补术比较的多中心回顾性研究[J].中国普通外科杂志, 2023, 32(10): 1469-1475.
[2]	Peterman DE, Warren JA.Ventral hernia management in obese patients[J].Surg Clin North Am, 2021, 101(2): 307-321.
[3]	Köckerling F, Sheen AJ, Berrevoet F, et al.The reality of general surgery training and increased complexity of abdominal wall hernia surgery[J].Hernia, 2019, 23(6): 1081-1091.
[4]	Pavithira GJ, Dutta S, Sundaramurthi S, et al.Outcomes of emergency abdominal wall hernia repair: experience over a decade[J].Cureus, 2022, 14(6): e26324.
[5]	Shao JM, Deerenberg EB, Elhage SA, et al.Are laparoscopic and open ventral hernia repairs truly comparable?: a propensity-matched study in large ventral hernias[J].Surg Endosc, 2021, 35(8):4653-4660.
[6]	储招钱, 胡金灵, 童丽芳.腹股沟疝术后补片区感染危险因素及感染菌群的研究[J].浙江创伤外科, 2021, 26(6): 1114-1115.
[7]	中华医学会外科学分会疝和腹壁外科学组.腹壁切口疝诊疗指南(2012 年版)[J/OL].中华疝和腹壁外科杂志(电子版), 2013, 7(2):104-106.
[8]	Marcolin P, de Figueiredo SMP, Constante MM, et al.Drain placement in retromuscular ventral hernia repair: a systematic review and meta-analysis[J].Hernia, 2023, 27(3): 519-526.
[9]	余成建, 冯樱.腹股沟疝Lichtenstein 无张力修补术后慢性疼痛的影响因素分析及预测模型建立[J].局解手术学杂志, 2021, 30(8):713-718.
[10]	李凯, 王勇, 段鑫, 等.肥胖症对腹股沟疝术后手术部位感染的影响及处理[J].中华内分泌外科杂志, 2017, 11(3): 233-235.
[11]	张业骞, 董中毅, 张子臻, 等.结直肠癌预防性末端回肠造口部位切口疝临床特征及危险因素分析[J].中国实用外科杂志, 2022,42(11): 1265-1269, 1275.
[12]	蒙建源, 黄海, 朱刚健.不同术式对腹股沟疝的治疗效果、预后及疼痛的影响因素分析[J].临床外科杂志, 2023, 31(4): 368-371.
[13]	刘瞻, 赵英丽, 陈晓婷.维生素D 水平与2 型糖尿病并发肺部感染患者免疫功能及其预后的关系[J].中华医院感染学杂志, 2022,32(9): 1295-1298.
[14]	李家云, 方朝晖, 赵进东, 等.丹蛭降糖胶囊联合硫辛酸、依帕司他对气阴两虚夹瘀型糖尿病周围神经病变患者血糖水平和下肢神经功能的影响[J].现代生物医学进展, 2022, 22(15): 2898-2902.
[15]	Kohno S, Hasegawa T, Aoki H, et al.Analysis of risk factors for surgical site infection and postoperative recurrence following inguinal and femoral hernia surgery in adults[J].Asian J Surg, 2022,45(4): 1001-1006.
[16]	Chugh S, Pietropaolo A, Montanari E, et al.Predictors of urinary infections and urosepsis after ureteroscopy for stone disease: a systematic review from EAU Section of Urolithiasis(EULIS)[J].Curr Urol Rep, 2020, 21(4): 16.
[17]	Dai W, Chen Z, Zuo J, et al.Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study[J].Hernia, 2019, 23(2): 267-276.
[18]	黄永刚, 叶静, 张方捷, 等.腹外斜肌转移肌瓣技术在巨大腹壁切口疝修补术中的应用价值[J].中华消化外科杂志, 2020, 19(7):757-761.
[19]	王苏, 武文杰, 毛淑平, 等.腹腔镜下腹股沟疝修补术后发生血清肿的影响因素分析[J].中国微创外科杂志, 2021, 21(11): 972-976.
[20]	黄玲玲, 赵晓飞, 辛晓阳, 等.PCT、CRP、SAA 和WBC 联合检测结合细菌培养对鲍曼不动杆菌感染的诊断价值[J].中国卫生检验杂志, 2022, 32(23): 2873-2878.
[21]	Oprea V, Buia F, Gheorghescu D, et al.Chronic mesh infection after incisional hernia repair.factors influencing negative outcomes of complete mesh removal[J].Chirurgia(Bucur), 2021, 116(3): 284-293.

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