Predictors for surgical site infection in patients undergoing therapeutic or prophylactic intra-abdominal onlay mesh (IPOM) implantation in clean and contaminated surgical fields.

BACKGROUND: Prophylactic intra-abdominal onlay mesh (IPOM) implantation has been shown to reduce the rate of fascial dehiscence and incisional hernia. However, surgical site infection (SSI) in presence of an IPOM remains a concern. The aim of this study was to assess predictors for SSI following IPOM placement in hernia and non-hernia abdominal surgery in clean and contaminated surgical fields. METHODS: Observational study including patients undergoing IPOM placement at a Swiss tertiary care hospital 2007-2016. IPOM implantation was performed in hernia and non-hernia elective and emergency abdominal surgery, including contaminated and infected surgical fields. The incidence of SSI was prospectively assessed by Swissnoso according to CDC criteria. The effect of disease- and procedure-related factors on SSI was assessed in multivariable regression analysis, adjusting for patient-related factors. RESULTS: A total of 1072 IPOM implantations were performed. Laparoscopy was performed in 415 patients (38.7%), laparotomy in 657 patients (61.3%). SSI occurred in 172 patients (16.0%). Superficial, deep, and organ space SSI were found in 77 (7.2%), 26 (2.4%), and 69 (6.4%) patients, respectively. Multivariable analysis revealed emergency hospitalization (OR 1.787, p = 0.006), previous laparotomy (1.745, p = 0.029), duration of operation (OR 1.193, p < 0.001), laparotomy (OR 6.167, p < 0.001), bariatric (OR 4.641, p < 0.001), colorectal (OR 1.941, p = 0.001), and emergency (OR 2.510, p < 0.001) surgery, wound class ≥ 3 (OR 3.878, p < 0.001), and non-polypropylene mesh (OR 1.818, p = 0.003) as independent predictors for SSI. Hernia surgery was independently associated with a lower risk for SSI (OR 0.165, p < 0.001). CONCLUSION: This study revealed emergency hospitalization, previous laparotomy, duration of operation, laparotomy, as well as bariatric, colorectal, and emergency surgery, abdominal contamination or infection, and usage of non-polypropylene mesh as independent predictors for SSI. In contrast, hernia surgery was associated with a lower risk for SSI. The knowledge of these predictors will help to balance benefits of IPOM implantation against the risk for SSI.

[Quality-oriented facility selection in the rehabilitation of the German pension insurance]. / Qualitätsorientierte Einrichtungsauswahl in der Rehabilitation der Deutschen Rentenversicherung.

According to Sixth Book of the Social Code (SGB VI), the German Pension Insurance (GPI) has the mandate to maintain or restore the employability of its insured persons. In order to achieve this goal, the GPI offers its insurees rehabilitation benefits. These are, on the one hand, services for prevention and medical rehabilitation (rehab) and, on the other hand, services for return-to-work or stay-at-work, respectively. In order to fulfill this mandate in the best possible way, in 1990 the GPI introduced instruments of external quality assurance (EQS) with scientific support. The system was firmly established in 1997. Since then, all rehab facilities owned and managed by the GPI are obliged to participate in the EQS system.Over the years, a large number of instruments and procedures have been developed that can map various aspects of quality as structure, process, and outcome. Until 2017, results of the EQS had no influence on the cooperation between the GPI and service providers. With the binding decision of the Federal Executive Board of the GPI in 2017, for the first time the GPI linked the allocation of rehab services for specific patients with the results of EQS. On this basis - confirmed by article 3 of the Digital Pension Overview Act - new paths are being taken. As part of the technically supported selection of a suitable facility for insured persons, quality should systematically and transparently acquire special importance and be consistently taken into account when occupying rehab facilities.This article gives an overview of the development of the proved and tested instruments of rehab quality assurance (QA), their current application, and an outlook on the rehab QA of the future.