Risk Factors Associated With Surgical Site Infection and Hernia Recurrence Following Ventral Hernia Mesh Repair: A Prospective Cohort Study

Introduction: The benefits of ventral hernia mesh repair are compromised by background of surgical-site infection (SSI) and recurrence. Methods: A prospective cohort design was set up for 240 adults who were undergoing elective ventral hernia mesh repair. Prespecified exposures were obesity, diabetes, smoking, defect width, mesh position, and operating time. The main outcome was superficial, deep, or organ-space SSI that occurred within 30 days, and clinical recurrence at 12 months was a secondary outcome. Results: 30 SSIs were included in 240 procedures (12.5%) in the constructed analysis figures. Infection was more frequent with BMI ≥30 kg/m² (22/120 versus 8/120; p=0.010), diabetes (17/80 versus 13/160; p=0.006), and smoking (14/62 versus 16/178; p=0.012). Twenty-four patients (11.1%) had a recurrence, and 216 patients had 12-month assessment. The incidence of recurrence was 10/26 (39%) in patients with prior SSI vs 14/190 (7%) in patients without SSI (p<0.001). Recurrence also was associated with wider defects. Conclusion: The drafting framework highlights the need for patient optimization, ongoing monitoring of infections and post-drafting of recurrent defects.