Diabetes mellitus linked to higher SSI risk after hernia repair, other factors not significantLarge study shows diabetes may raise infection risk during hernia repair surgery for patients

Frontiers in Medicine Published June 3, 2026 DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Interpret diabetes as a modest, inconsistent risk factor for SSI after hernia repair; other variables were not significant.

This systematic review and meta-analysis examined the association between patient-related variables and surgical site infection (SSI) and hernia recurrence after abdominal wall hernia repair. The analysis included 97,428 patients from multiple cohorts. The primary outcomes were SSI and hernia recurrence.

Among the variables assessed, diabetes mellitus showed a nominally significant association with increased SSI risk (OR 1.46, 95% CI 1.01-2.11, P = 0.04), but the 95% prediction interval was wide (0.55-3.90), indicating considerable inconsistency across studies. Female sex (OR 1.05, 95% CI 0.77-1.42, P = 0.77), obesity (OR 1.15, 95% CI 0.78-1.68, P = 0.48), COPD (OR 0.95, 95% CI 0.47-1.92, P = 0.88), and immunosuppressive therapy (OR 0.90, 95% CI 0.38-2.14, P = 0.81) were not significantly associated with SSI.

The authors note that the wide prediction interval for diabetes mellitus suggests considerable inconsistency across cohorts, limiting the certainty of the finding. Other limitations include potential confounding and the observational nature of included studies, precluding causal conclusions.

Clinically, identifying patient-related risk factors remains important for perioperative management, but the evidence for most factors is weak. Diabetes may warrant closer monitoring, but the association is modest and inconsistent.

This big study looked at many different patients who had surgery to fix a bulge in their belly wall. The doctors wanted to know if certain health problems made it more likely for an infection to start at the cut site. They checked over ninety-seven thousand people to see if their personal health history mattered.

The results showed that being a woman, being overweight, or having lung trouble did not change the risk of infection. Even taking special medicines to boost the immune system did not make a big difference in the final results for most people in the group.

However, having diabetes did show a small increase in the chance of getting an infection. The numbers were not very clear because they varied a lot between different hospitals and doctors. This means the result might not be the same everywhere.

Knowing which health problems matter helps doctors take better care of patients before and after surgery. It is important to understand these risks so doctors can plan better treatments for everyone.

What this means for you:

Diabetes may slightly raise infection risk after hernia repair, while other conditions like obesity or lung disease did not show a clear effect.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

BackgroundSurgical site infection (SSI) and hernia recurrence are among the most common and impactful complications following abdominal wall hernia repair. Identifying patient-related risk factors is essential for improving outcomes and guiding perioperative management.MethodsA systematic review and meta-analysis were conducted in accordance with PRISMA 2020 and AMSTAR 2 guidelines. PubMed, Embase, Scopus, CNKI,Wanfang, and VIP were searched up to September 20,2025. Eligible studies included randomized controlled trials, cohort, and case-control studies that reported associations between patient-related variables and SSI or recurrence after hernia repair. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Beyond I2, the 95% prediction interval (PI) was utilized as the primary metric to evaluate the absolute dispersion of true effects. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS).ResultsA total of 11 studies involving 97,428 patients were included. No significant associations were observed for female sex (OR: 1.05, 95% CI: 0.77–1.42, P = 0.77; 95% PI: 0.48–2.29), obesity (OR: 1.15, 95% CI: 0.78–1.68, P = 0.48; 95% PI: 0.37–3.55), COPD (OR: 0.95, 95% CI: 0.47–1.92, P = 0.88; 95% PI: 0.14–6.25), or immunosuppressive therapy (OR 0.90, 95% CI: 0.38–2.14, P = 0.81). Although diabetes mellitus reached nominal statistical significance (OR: 1.46, 95% CI: 1.01–2.11, P = 0.04), its wide 95% PI (0.55–3.90) suggested considerable inconsistency across cohorts. Similarly, higher ASA classification (>3 vs.

Diabetes mellitus linked to higher SSI risk after hernia repair, other factors not significantLarge study shows diabetes may raise infection risk during hernia repair surgery for patients

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Diabetes mellitus linked to higher SSI risk after hernia repair, other factors not significantLarge study shows diabetes may raise infection risk during hernia repair surgery for patients

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