Ina Soh, MD, Andrew Luhrs, MD, Sivamainthan Vithiananthan, MD, FACS, FICS, David Cloutier, MD, FACS. Brown University
INTRODUCTION: Nearly one in three Americans are obese. As a result, general surgeons frequently encounter this population for general surgery complaints. Numerous scoring systems have been suggested for predicting surgical site infection (SSI); however, obesity is not considered when calculating these scores. We hypothesized that obese patients will have a higher incidence of SSI and questioned whether there is a BMI threshold above which perioperative protocols should be adjusted to reduce incidence of SSI.
METHODS: We elected to analyze patients undergoing laparoscopic appendectomy as this is a commonly performed, laparoscopic procedure which allowed for sufficient power and minimized bias introduced by incisional length. The ACS-NSQIP database was queried retrospectively for all patients who underwent laparoscopic appendectomy nationally between January 2005 and December 2013. Exclusion criteria included: height and weight not recorded, 50% of covariates missing, pregnancy, conversion to open appendectomy. Primary outcome was SSI within 30 days defined as: purulent drainage from incision, isolated organisms from incision, or peri-incisional swelling, erythema, and warmth. Categorical data were analyzed using Fisher’s exact test and continuous data were analyzed using Student/Welch’s T-test. Multivariate regression analysis was used for predicting SSI as a primary outcome.
RESULTS: A total of 78,326 cases were identified using the above criteria. 2192 (2.79%) patients developed a SSI in the perioperative period. When comparing patients who developed SSI to those who did not, patients who developed SSI were more likely to be: male (56.1% vs 49.9%; p = 0.041), black (9.8% vs 7.5%; p=0.003), diabetic (7.3% vs 5.0%; p = 0.021), an active smoker (24.6% vs 20.9%; p = 0.04 ), and hypoalbuminemic (11.0% vs 6.8%; p=0.038). In the SSI group, mean BMI was significantly higher (30.1 vs 28.0; p=0.002). Patients with a BMI of 30 or greater had increased odds of SSI (OR 2.3, 95%CI 1.3-4.5) after adjusting for gender, age, ethnicity, preoperative risk factors, comorbidities, and presence of perforation or abscess.
CONCLUSION: Patients with a BMI of 30 or greater undergoing laparoscopic appendectomy are more likely to develop a SSI. Perioperative protocols should be adjusted in these patients to reduce incidence of SSI. Further study is required to identify interventions which effectively reduce SSI in this population. We recommend the development and implementation of a perioperative care bundle for obese surgical patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79700
Program Number: S082
Presentation Session: SAGES Got Talent : Resident & Fellow Scientific Session
Presentation Type: ResFel