Body mass index and the risk of deep surgical site infection following posterior cervical instrumented fusion

Background: According to the CDC NHSN, surgical site infections (SSI) are wound infections that develop within 30 days postoperatively for nonimplanted surgeries such as cesarean sections. SSIs is shown to manifest in a continuum of a purulent discharge from surgical site to severe sepsis. It contributes to rising morbidity, mortality and prolonged length of stay. Objective: To describe risk factors to the development of SSI in cesarean section in descriptive studies. Methods: The Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guidelines is used as method for this systematic review. A PubMed literature search was conducted, limited to published articles in English from 1998 to 2016 using the broad key terms “cesarean section,” “surgical site infection,” and “risk factor.” The following inclusion criteria were applied to all reviews: (1) peer-reviewed journal, (2) computed risk factor for SSI development, and (3) calculated SSI rate. Reviews of references of the include studies were conducted, and 7 studies were appraised, with only 1 accepted. Results: After extracting data from 52 article reviews, 23 were finally accepted based on the inclusion criteria. Most studies were multivariate studies (n = 8) followed by cohort studies (n = 6). Unique numerators and denominators for SSI reviews were mentioned in all 23 studies, of which 22 studies followed the CDC NHSN definitions for SSI. Within the 23 studies, most studies showed that obesity (11.46%) is a common maternal risk factor for the development of postoperative cesarean section SSI. Conclusions: Identifying that obesity is a major contributor of surgical site infection in postoperative cesarean section women is a topic that warrants exploration. The relationship of cesarean section SSI to obesity should be investigated, specifically highlighting the level of obesity based on the WHO international body mass index (BMI) classification and the development of SSI. A correlation between increasing wound infection rates and increasing body mass index should be studied further. Published recommendations for preventing SSIs in this population should be reviewed.Funding: NoneDisclosures: None

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The effect of body mass index on the risk of surgical site infection

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.165 ◽

2019 ◽

Vol 40 (9) ◽

pp. 991-996 ◽

Cited By ~ 5

Author(s):

Anouk P. Meijs ◽

Mayke B.G. Koek ◽

Margreet C. Vos ◽

Suzanne E. Geerlings ◽

H. Charles Vogely ◽

...

Keyword(s):

Body Mass Index ◽

Surgical Site Infection ◽

Body Mass ◽

Surgical Procedures ◽

Hip Prosthesis ◽

Normal Weight ◽

Morbidly Obese ◽

Obese Patients ◽

Site Infection ◽

Total Hip Prosthesis

AbstractObjective:Obesity is considered a risk factor for surgical site infection (SSI). We quantified impact of body mass index (BMI) on the risk of SSI for a variety of surgical procedures.Methods:We included 2012–2017 data from the Dutch national surveillance network PREZIES on a selection of frequently performed surgical procedures across different specialties. Patients were stratified into 5 categories: underweight (BMI, <18.5 kg/m2), normal weight (BMI, 18.5–25), overweight (BMI, 25–30), obese (BMI, 30–40) and morbidly obese (BMI, ≥40). Multilevel log binomial regression analyses were performed to assess the effect of BMI category on the risk of superficial, deep (including organ-space) and total SSI.Results:Of the 387,919 included patients (ranging from 2,616 for laparoscopic appendectomy to 119,834 for total hip prosthesis), 3,676 (1%) were underweight, 116,778 (30%) had normal weight, 154,339 (40%) were overweight, 104,288 (27%) had obesity, and 8,838 (2%) were morbidly obese. A trend of increasing risk of SSI when BMI increased from normal to morbidly obese was observed for almost all surgery types. The increase was most profound in surgeries with clean wounds, with relative risks for morbidly obese patients ranging up to 7.8 (95% CI, 6.0–10.2) for deep SSI in total hip prosthesis. In chest and abdominal surgeries, the impact was larger for superficial SSI than for deep SSI.Conclusions:The results of our research provide evidence for the need of preventive programs targeting SSI in overweight and obese patients, as well as for the prevention of obesity in the general population.

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