The surgeon as a risk factor for complications of midline incisions

Abstract

Objective: To compare among surgeons the risk‐adjusted rates of wound infection and incisional hernia after midline incisions. Design: Prospective clinical study. Setting: County hospital, Sweden. Subjects: 1013 patients who underwent midline laparotomy between August 1989 and June 1993. Interventions: Wounds were sutured by a continuous technique and details of patients and operations were recorded. The suture technique was monitored by the suture length:wound length ratio. Main outcome measures: Postoperative wound infection, and incidence of incisional hernia at 12 months. Results: The details of patients and operations varied significantly among surgeons. Senior surgeons sutured with a lower suture length:wound length ratio than juniors (mean (SD) 4·1 (1·4) compared with 5·3 (2·1), p < 0·01). The individual rates of wound infection varied from 0 to 27% (mean 10%) and that of incisional hernia from 5% to 26% (mean 15%). After correction for patient selection three surgeons had significantly higher rates of wound infection and one significantly lower than the others, two surgeons had significantly higher rates of incisional hernia and two significantly lower. Only one surgeon differed significantly in the rate of incisional herniation after also adjusting for the suture technique. The length of surgical experience did not affect the rate of wound complications. Conclusion: The suture technique, monitored by the SL:WL ratio, is the most important factor for variability in the incidence of incisional hernia among surgeons in continuously sutured midline incisions. The suture technique may also help to explain the variability in rates of wound infection. Copyright © 1998 Taylor and Francis Ltd.