Antimicrobial-Impregnated Surgical Incise Drapes in the Prevention of Mesh Infection after Ventral Hernia Repair

Background: Antimicrobial surgical incise drapes are used in an effort to lower the risk of mesh infection after hernia repair. The effect such drapes on infection rates was examined. Methods: Ventral or incisional hernia repairs with mesh from March, 2002, to June, 2006 gathered from the local American College of Surgeons-National Surgical Quality Improvement Project database, chart review, and operating room database were reviewed. Mesh infection was defined as infection necessitating mesh removal. Significant univariate predictors of infection were included in a logistic regression model. Mesh infections were divided into early (0-7 days), midterm (8-50 days), and late (>50 days) onset for subgroup analysis. Results: Five hundred six hernia repairs and 42 mesh infections (8.3%) were identified (range 1-947 days), the latter consisting of seven early (16.7%), 13 midterm (31.0%), and 22 late (53.4%) infections. Antimicrobial-impregnated incise drapes were used in 206 cases in the entire series (59.1%). By multivariable analysis, factors significantly associated with incise drape use were laparoscopic repair (odds ratio [OR] 3.03; p < 0.0001), per-year resident level (OR 1.21; p = 0.0012), high-volume surgeon (OR 1.74; p = 0.021), clean wound classification (OR 2.21; p = 0.0076), current or recent smoking (OR 1.61; p = 0.039), and chronic steroid use (OR 0.31; p = 0.044). Predictors of mesh infection in multivariable analysis were repair of recurrent hernia (OR 3.72; p < 0.0001), current or recent smoking (OR 2.18; p = 0.027), and per-minute operation time (OR 1.007; p = 0.0004). Missed enterotomy was the only factor significantly associated with time to mesh infection (75% in the early group; p < 0.0001). Conclusion: At our institution, antimicrobial-impregnated incise drapes are most likely to be used by the highest-volume hernia repair surgeons and more experienced residents in clean, elective, laparoscopic cases. However, reduction in the mesh infection rate was not observed with their use. Independent predictors of mesh infection included repeat surgery, smoking, and longer operating time. The time from operation to mesh infection differed greatly. Not unexpectedly, mesh infection within seven days after implantation was strongly related to a missed enterotomy.