The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery

Introduction: The purpose of this study was to evaluate the long-term complications of surgical site infection (SSI) in the colorectal population, specifically its association with incisional hernia and small bowel obstruction. Methods: Using standardized definitions of SSI, a retrospective review of patients undergoing transabdominal colorectal surgery from January 2002 to December 2005 was performed. Primary outcomes included incisional hernia and small bowel obstruction in patients with SSIs. Results: A total of 443 patients were analyzed. The median surgical follow-up was 12 months (23,091 days). Infections were identified in 101 (23%) cases. There were 99 cases (22%) of incisional hernia and 32 cases (7%) of small bowel obstruction. Logistic regression revealed SSI to be independently associated with incisional hernia after adjusting for clinical covariates (adjusted odds ratio = 2.23, P =.003; 95% confidence interval, 1.33.8). Patients with incisional hernia were 1.9 times more likely to have had an SSI (36.3% vs 18.8%, P ≤.01). They required a longer operative time (224 minutes vs 198 minutes, P =.03), had an increased body mass index (29.0 vs 26.8, P ≤.01), and had increased estimated blood loss (363 vs 289, mL, P =.03). Small bowel obstruction was significantly associated with operations involving the rectum (11.5% in operations involving the rectum vs 5.9% in nonrectal operations, P =.05), increased estimated blood loss (409 ml vs 297 ml, P =.04), and red blood cell transfusion (15.5% with transfusion vs 5.7% without, P =.01). SSI was not an independent predictor of small bowel obstruction (adjusted odds ratio = 1.05, P =.91; 95% confidence interval,.452.5). Conclusions: Patients with an SSI were 1.9 times more likely to have an incisional hernia than those without an SSI. An SSI after colorectal surgery was a risk factor for the development of incisional hernia but was not a risk factor for small bowel obstruction in our population.