A High Visceral-To-Subcutaneous Fat Ratio is an Independent Predictor of Surgical Site Infection after Gastrectomy

Recent studies have shown that body composition is an important factor that affects surgical site infection (SSI). However, each study has utilized different body composition criteria. Therefore, in this study, we aim to determine the most predictable body composition criteria for the prediction of SSI after gastrectomy. The visceral fat area (VFA), subcutaneous fat area (SFA), and muscle area were assessed by a preoperative-stage computed tomographic (CT) scan. To compare the predictive performance of body composition for SSI, logistic regression models were used, and the models were compared using the receiver operation characteristic (ROC) curve and the area under the curve (AUC) value. Of the 1038 eligible patients, 58 patients (5.6%) developed SSI. The VFA-to-SFA ratio showed the best predictive performance (mean AUC 75.11). The cutoff value for the SSI of the VFA-to-SFA ratio was 0.94, and the sensitivity and specificity were 67.86% and 77.65%, respectively. A multivariate logistic analysis indicated that a total gastrectomy (OR, 2.13; p = 0.017), stage III or IV cancer (OR, 2.66; p = 0.003), and a high VFA-to-SFA ratio (OR, 8.09; p < 0.001) were independent risk factors for SSI after gastrectomy. The VFA-to-SFA ratio is the most predictable body composition model for use in predicting the incidence of SSI after gastrectomy.

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896. Prediction of Surgical Site Infection Risk in Patients Undergoing Bariatric Surgery

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1084 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S482-S483

Author(s):

Flávio Henrique Batista de Souza ◽

Braulio Roberto Gonçalves Marinho Couto ◽

Felipe Leandro Andrade da Conceição ◽

Gabriel Henrique Silvestre da Silva ◽

Igor Gonçalves Dias ◽

...

Keyword(s):

Bariatric Surgery ◽

Data Collection ◽

Surgical Site Infection ◽

Predictive Power ◽

Area Under The Curve ◽

Site Infection ◽

Weight Decay ◽

Hospital Infection Control ◽

Duration Of Surgery ◽

Belo Horizonte

Abstract Background In the hospitals of Belo Horizonte (a city with more than 3,000,000 inhabitants), a survey was conducted between July 2016 and June 2018, focused on surgical site infection (SSI) in patients undergoing bariatric surgery procedures. The main objective is to statistically evaluate such incidences and enable a study of the prediction power of SSI through MLPs (Multilayer Perceptron), a pattern recognition algorithm. Methods Data were collected on SSI by the Hospital Infection Control Committees (CCIH) of the hospitals involved in the research. After data collection, three procedures were performed: a treatment of the database collected for the use of intact samples; a statistical analysis on the profile of the hospitals collected and; an assessment of the predictive power of five types of MLP (Backpropagation Standard, Momentum, Resilient Propagation, Weight Decay, and Quick Propagation) for SSI prediction. MLPs were tested with 3, 5, 7, and 10 hidden layer neurons and a database split for the resampling process (65% or 75% for testing, 35% or 25% for validation). They were compared by measuring AUC (Area Under the Curve - ranging from 0 to 1) presented for each of the configurations. Results From 3473 initial data, only 2491 were intact for analysis. Statistically, it was found that: the average age of the patients was 39 years (ranging from 16 to 65); the average duration of surgery was 138 minutes; and 0.8% of patients had SSI. Regarding the predictive power of SSI, the experiments have a minimum value of 0.350 and a maximum of 0.756. Conclusion Despite the loss rate of almost 30% of the database samples due to the presence of noise, it was possible to have a relevant sampling for the profile evaluation of Belo Horizonte hospitals. Moreover, for the predictive process, although some configurations have results that reached 0.755, which makes promising the use of the structure for automated SSI monitoring for patients undergoing bariatric surgery. To optimize data collection and enable other hospitals to use the SSI prediction tool (available in www.sacihweb.com), two mobile application were developed: one for monitoring the patient in the hospital and the other for monitoring after hospital discharge. Disclosures All Authors: No reported disclosures

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Surgical Site Infection and Analytic Morphometric Assessment of Body Composition in Patients Undergoing Midline Laparotomy

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2011.04.008 ◽

2011 ◽

Vol 213 (2) ◽

pp. 236-244 ◽

Cited By ~ 60

Author(s):

Jay S. Lee ◽

Michael N. Terjimanian ◽

Lindsay M. Tishberg ◽

Abbas Z. Alawieh ◽

Calista M. Harbaugh ◽

...

Keyword(s):

Body Composition ◽

Surgical Site Infection ◽

Site Infection ◽

Midline Laparotomy ◽

Morphometric Assessment

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SP1.1.17The relationship between colorectal neoplasia and body composition in a bowel screening population

British Journal of Surgery ◽

10.1093/bjs/znab361.012 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Domenic Di Rollo ◽

Christopher Morton ◽

Donald McMillan ◽

Paul Horgan ◽

David Mansouri

Keyword(s):

Body Composition ◽

Virtual Colonoscopy ◽

Colorectal Neoplasia ◽

Demographic Data ◽

Multivariable Analysis ◽

Subcutaneous Fat ◽

Visceral Obesity ◽

Visceral Fat Area ◽

Increased Risk ◽

Male Sex

Abstract Aims Conflicting evidence exists as to the effect of elevated BMI in the development of colorectal neoplasia. Yet BMI is a crude measure of adiposity. The present study investigates the association between CT derived measures of body composition including sarcopenia, subcutaneous fat index (SFI) and visceral obesity and colorectal neoplasia. Methods 358 consecutive patients undergoing CT virtual colonoscopy (CTC) as part of the Scottish Bowel Screening Programme were eligible for inclusion. Demographic data and the above measures body composition were calculated using previously published CT derived methods. Medical records were examined for colonoscopic findings and pathology reports. Results 121/358 (34%) were males. Median age 65. 126/358 (35%) patients were found to have a colorectal neoplasia. 84/126 (67%) had advanced neoplasia. 26/358 (7%) had adenocarcinoma. On multivariable analysis, both male sex and visceral obesity was associated with the presence of colorectal neoplasia, OR 2.62, [95% CI 1.51-4.55, p = 0.001] and OR 2.83, {95% CI 1.25-6.41, p = 0.01] respectively. The relationship was dose dependent with an increased risk of colorectal neoplasia in the 3rd [OR 2.13 95% CI 1.09-4.14 p < 0.05] and 4th [OR 3.77 95% CI 1.96-7.26 p < 0.001] quartiles of visceral fat area. BMI, SFI and sarcopenia were not associated with colorectal neoplasia in the present study. Conclusions Male sex and in particular, visceral obesity is associated with increased risk of colorectal neoplasia. In addition to the known cardiovascular and metabolic dangers of visceral obesity, the present work suggests that visceral obesity may also play a role in colorectal neoplasia formation.

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Efficacy of Non-Beta-lactam Antibiotics for Prevention of Cesarean Delivery Surgical Site Infections

American Journal of Perinatology Reports ◽

10.1055/s-0039-1685503 ◽

2019 ◽

Vol 09 (02) ◽

pp. e167-e171 ◽

Cited By ~ 3

Author(s):

Benjamin Harris ◽

Maeve Hopkins ◽

Margaret Villers ◽

Jeremy Weber ◽

Carl Pieper ◽

...

Keyword(s):

Surgical Site Infection ◽

Cesarean Delivery ◽

Surgical Site Infections ◽

Type I ◽

Site Infection ◽

Beta Lactam ◽

Postpartum Visit ◽

Chi Square ◽

Lower Odds ◽

Logistic Regression Models

Objective To examine the association between perioperative Beta (β))-lactam versus non-β-lactam antibiotics and cesarean delivery surgical site infection (SSI). Study Design Retrospective cohort of women undergoing cesarean delivery from January 1 to December 31, 2014. All women undergoing cesarean after 34 weeks with a postpartum visit were included. Prevalence of SSI was compared between women receiving β-lactam versus non-β-lactam antibiotics. Bivariate analyses were performed using Pearson's Chi-square, Fisher's exact, or Wilcoxon's rank-sum tests. Logistic regression models were fit controlling for possible confounders. Results Of the 929 women included, 826 (89%) received β-lactam prophylaxis and 103 (11%) received a non-β-lactam. Among the 893 women who reported a non-type I (low risk) allergy, 819 (92%) received β-lactam prophylaxis. SSI occurred in 7% of women who received β-lactam antibiotics versus 15% of women who received a non-β-lactam (p = 0.004). β-Lactam prophylaxis was associated with lower odds of SSI compared with non-β-lactam antibiotics (odds ratio [OR] = 0.43; 95% confidence interval [CI] = 0.22–0.83; p = 0.01) after controlling for chorioamnionitis in labor, postlabor cesarean, endometritis, tobacco use, and body mass index (BMI). Conclusion β-Lactam perioperative prophylaxis is associated with lower odds of a cesarean delivery surgical site infection compared with non-β-lactam antibiotics.

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First Results of the Swiss National Surgical Site Infection Surveillance Program: Who Seeks Shall Find

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.55 ◽

2017 ◽

Vol 38 (06) ◽

pp. 697-704 ◽

Cited By ~ 22

Author(s):

Nicolas Troillet ◽

Emin Aghayev ◽

Marie-Christine Eisenring ◽

Andreas F. Widmer ◽

Keyword(s):

Surgical Site Infection ◽

Temporal Trends ◽

Colon Surgery ◽

Surveillance Program ◽

Site Infection ◽

Post Discharge ◽

Public And Private ◽

Logistic Regression Models ◽

First Results ◽

The Impact

OBJECTIVES To report on the results of the Swiss national surgical site infection (SSI) surveillance program, including temporal trends, and to describe methodological characteristics that may influence SSI rates DESIGN Countrywide survey of SSI over a 4-year period. Analysis of prospectively collected data including patient and procedure characteristics as well as aggregated SSI rates stratified by risk categories, type of SSI, and time of diagnosis. Temporal trends were analyzed using stepwise multivariate logistic regression models with adjustment of the effect of the duration of participation in the surveillance program for confounding factors. SETTING The study included 164 Swiss public and private hospitals with surgical activities. RESULTS From October 2011 to September 2015, a total of 187,501 operations performed in this setting were included. Cumulative SSI rates varied from 0.9% for knee arthroplasty to 14.4% for colon surgery. Postdischarge follow-up was completed in >90% of patients at 1 month for surgeries without an implant and in >80% of patients at 12 months for surgeries with an implant. High rates of SSIs were detected postdischarge, from 20.7% in colon surgeries to 93.3% in knee arthroplasties. Overall, the impact of the duration of surveillance was significantly and independently associated with a decrease in SSI rates in herniorraphies and C-sections but not for the other procedures. Nevertheless, some hospitals observed significant decreases in their rates for various procedures. CONCLUSIONS Intensive post-discharge surveillance may explain high SSI rates and cause artificial differences between programs. Surveillance per se, without structured and mandatory quality improvement efforts, may not produce the expected decrease in SSI rates. Infect Control Hosp Epidemiol 2017;38:697–704

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Usefulness of Lymphocyte ratio and CRP Level for Early Detection of Surgical Site Infection Following spinal surgery

10.21203/rs.2.15566/v1 ◽

2019 ◽

Author(s):

Wenbo Wei ◽

Shajie Dang ◽

Dapeng Duan ◽

Liqun Gong ◽

Jue Wang ◽

...

Keyword(s):

Surgical Site Infection ◽

Spinal Surgery ◽

Operating Characteristic ◽

Characteristic Curve ◽

Area Under The Curve ◽

Site Infection ◽

C Reactive Protein ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Operating Characteristic Curve

Abstract Background: To investigate the significant laboratory markers for early diagnosis of surgical site infection after spinal surgery. And determine the diagnostic cut-off values of these markers Methods: A total of 67 patients participated in the study: 11 patients who developed surgical site infection after spinal surgery (SSI Group) and 56 patients were compared with the infected group in terms of age，gender, operating time and intraoperative blood loss (Non-SSI Group). The white blood cell (WBC) count , WBC differential , C-reactive protein (CRP) and erythrocyte sedimentation rate(ESR) were determined before and 1, 3 and 7 days postoperatively . Then, we determine the diagnostic cutoff for these markers by using the receiver operating characteristic curve. Results: The CRP, ESR and WBC were significantly higher in the SSI group at 3 and 7 days postoperatively. The lymphocyte ratio at 3 days postoperatively was significantly lower in the SSI Group. Using the receiver operating characteristic curve，lymphocyte ratio <11.5% at 3 days postoperatively (sensitivity 90.9%, specificity 75.4%, area under the curve [AUC] 0.919), and C-reactive protein level >26 mg/dL at 7 days postoperatively (sensitivity 90.9%, specificity 87.7%, area under the curve [AUC] 0.954) were the significant laboratory marker for early detection of SSI Conclusion: Lymphocyte ratio<11.5% at 3 days and C-reactive protein levels>26.5mg/dl at 7 days after spinal surgery are reliable markers of SSI.

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69 A new frame score system for Nelore cattle

Journal of Animal Science ◽

10.1093/jas/skaa278.086 ◽

2020 ◽

Vol 98 (Supplement_4) ◽

pp. 47-47

Author(s):

Roberto D Sainz ◽

Nayanny Guimarães ◽

Cláudio U Magnabosco ◽

Fernando Lopes

Keyword(s):

Body Composition ◽

Beef Cattle ◽

Genetic Parameters ◽

Genetic Correlations ◽

Subcutaneous Fat ◽

Heritability Estimate ◽

Reproductive Traits ◽

Carcass Weight ◽

Muscle Area ◽

Nelore Cattle

Abstract Frame score (FS) systems for beef cattle generally represent the relationships among growth, body composition, reproduction and mature size, in a simple and practical form. This study aimed to: 1) develop a FS system for Nelore cattle that is biologically sound, easy to interpret, and useful for producers; and 2) estimate the genetic parameters of the FS with productive and reproductive traits. An arbitrary scale (1 to 12) was devised so that each unit corresponds to 15 kg of carcass weight (1 @), as this is a common measure used for marketing beef cattle in Brazil. Therefore, ideal carcass weight, defined as having 6 mm of backfat, would be 18 @ (269 kg) and 15 @ (224 kg) for FS = 6 males and females, respectively. Data from 36,030 animals (22,405 males, 13,565 females) raised on pasture were obtained from participating herds of the National Association of Breeders and Researchers (ANCP). Genetic parameters were estimated in uni- and bicharacteristic analyses under an animal model, using the EM-REML algorithm (AIREMLF90) and Bayesian inference (GIBBS1F90). The heritability estimate for the new FS was 0.38, and its additive genetic correlations were 0.70, 0.72, 0.77, 0.33, -0.57, 0.27, and 0.28 with BW at 365 d, BW at 450 d, hip height, longissimus muscle area, subcutaneous fat thickness, scrotal circumference at 450 d, and age at first calving, respectively. The estimated heritability and genetic correlations indicate that there is enough additive genetic variability to allow for genetic response to selection. The estimates support the notion that larger frame animals are taller, heavier, leaner and later maturing, both in body composition as well as sexually. The new frame score may be a useful tool for genetic selection of animals that are best suited to their environment.

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Subcutaneous Fat Thickness and the Risk of Superficial Incisional Surgical Site Infection Following Open Appendectomy

Nepal Medical College Journal ◽

10.3126/nmcj.v23i1.36218 ◽

2021 ◽

Vol 23 (1) ◽

pp. 1-5

Author(s):

Subash Rai ◽

P Poudel ◽

A Chalise ◽

M Nepal ◽

M Shrestha

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Open Appendectomy ◽

Subcutaneous Fat ◽

Site Infection ◽

Female Population ◽

Wound Site ◽

Incisional Surgical Site Infection ◽

Subcutaneous Fat Thickness ◽

Fat Thickness

Obesity is a known risk factor for surgical site infection (SSI). Recent studies have demonstrated that fat burden at the incisional site rather than body mass index (BMI) is a more precise and sensitive measure to predict the risk of SSI. The purpose of the study was to evaluate the correlation between subcutaneous fat thickness (SCFT) at the level of Mc Burney’s point and the occurrence of superficial incisional SSI among the patients undergoing open appendectomy. A total of 120 patients who underwent open appendectomy were included in the study. SCFT was measured preoperatively with ultrasonography (USG). The occurrence of superficial incisional SSI was evaluated in relation to SCFT. Previously identified well established risk factors for the development of SSI were also considered by the study. Statistical analysis was performed using SPSS version 17. Overall, superficial incisional SSI was observed in 27 (22.5%) participants. Mean SCFT at the level of Mc Burney’s point among male and female population was 2.26 cm ± 0.74 (SD) and 2.02 cm ± 0.83 (SD) respectively. Patients with superficial incisional SSI had a mean fat thickness of 2.80 cm and those without SSI had mean fat thickness of 1.97 cm. The difference in SCFT was statistically significant (p=.001). More interestingly, the area under the ROC curve was more for SCFT, in comparison to BMI among the patients who developed superficial incisional SSI (81% vs. 73%). Furthermore, we analysed the occurrence of superficial incisional SSI with SCFT cut off at 2.80 cm, which was statistically significant. As majority of the study population were young adults, risk factors like smoking, diabetes mellitus and nutritional status failed to demonstrate significant correlation with post appendectomy wound site complications. The study demonstrated that the thickness of subcutaneous fat at the site of inci sion is a good predictor of superficial incisional SSI following open appendectomy and the risk of superficial wound site infection increases as the thickness of subcutaneous fat at the site of incision increases.

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Body Composition Influences Post-Operative Complications and 90-Day and Overall Survival in Pancreatic Surgery Patients

GE Portuguese Journal of Gastroenterology ◽

10.1159/000507206 ◽

2020 ◽

Vol 28 (1) ◽

pp. 13-25

Author(s):

Sónia Velho ◽

Maria Pia Costa Santos ◽

Cátia Cunha ◽

Lisa Agostinho ◽

Rita Cruz ◽

...

Keyword(s):

Overall Survival ◽

Body Composition ◽

Postoperative Complications ◽

Pancreatic Surgery ◽

Cox Proportional Hazards ◽

High Morbidity ◽

Muscle Area ◽

Visceral Fat Area ◽

Radiation Attenuation ◽

Increased Risk

Introduction: Pancreatic surgery still carries a high morbidity and mortality even in specialized centers. The aim of this study was to evaluate the influence of patients’ body composition on postoperative complications and survival after pancreatic surgery. Methods: This was a retrospective study on patients undergoing pancreatic surgery between March 2012 and December 2017. Demographics, clinical data, and postoperative complications classified according to Clavien-Dindo were recorded. Body composition was assessed using routine diagnostic or staging computed tomography (CT). Multiple Cox proportional hazards models were adjusted. Results: Ninety patients were included, 55% were male, and the mean age was 68 ± 10.9 years. Of these 90, 92% had a total pancreatectomy or pancreaticoduodenectomy, 7% a distal pancreatectomy, and 1% a pancreaticoduodenectomy with multi-visceral resection; 84% had malignant disease. The incidence of major complications was 27.8% and the 90-day mortality was 8.8%. The ratio of visceral fat area/skeletal muscle area (VFA:SMA) was associated with an increased risk of complications (OR 2.24, 95% CI 1.14–4.87, p = 0.03) and 90-day survival (HR 2.13, 95% CI 1.13–4.01, p = 0.019). On simple analysis, shorter overall survival (OS) was observed in patients aged ≥70 years (p = 0.0009), with postoperative complications ≥IIIb (p = 0.01), an increased VFA:SMA (p = 0.007), and decreased muscle radiation attenuation (p = 1.6 × 10–5). In an OS model adjusted for age, disease malignancy, postoperative complications, and body composition parameters, muscle radiation attenuation remained significantly associated with survival (HR 0.94, 95% CI 0.90–0.98, p = 0.0016). A model which included only body composition variables had a discrimination ability (C-statistic 0.76) superior to a model which comprised conventional clinical variables (C-statistic 0.68). Conclusion: Body composition is a major determinant of postoperative complications and survival in pancreatic surgery patients.

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