Body Mass Index: Surgical Site Infections and Mortality after Lower Extremity Bypass from the National Surgical Quality Improvement Program 2005–2007

Abstract

Objectives-Patients undergoing lower extremity bypass are at high risk for surgical site infections (SSI). We examine lower extremity bypasses by graft origin and body mass index (BMI) classification to analyze differences in postoperative mortality and SSI occurrence. Methods-The 2005-2007National Surgical Quality Improvement Program (NSQIP), a multiinstitutional risk-adjusted database, was queried to compare perioperative mortality (30-day), overall morbidity, and SSIs after lower extremity arterial bypass for peripheral arterial disease. Bypass was stratified by graft origin as aorto-iliac, femoral, or popliteal. Patient demographics, comorbidities, operative, and post-operative occurrences were analyzed.

Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country

“…Higher ASA class was a risk factor for SSI among our laparotomy patients, confirming prior reports. [19][20][21][22][23][24] Potential explanations for the link between SSI and obesity include increased thickness of poorly vascularized subcutaneous adipose tissue layer, local tissue trauma resulting from excessive retraction, and higher bacterial density at abdominal or groin creases. Therefore, careful attention to closure technique and proper choice and dosing of prophylactic antibiotics might be helpful in lowering the incidence of SSI in obese patients.…”

Surgical wound infections after peripheral vascular surgery

“…Furthermore, obesity has increased the risk of SWI after peripheral artery surgery in other studies with smaller number of patients with an OR varying between 1.7 and 6.08 (11,13,23,25,39). In addition, morbid obesity (body mass index (bmI) ≥ 40 kg/m 2 ) has been found to be an independent risk factor for SWI after open aortic aneurysm repair with an OR of 2.6 (16).…”

Development of Risk Scoring Tool to Predict Surgical Site Infections

“…(OR = 1.7, 95% CI: 1.4-2.1) [16]. In addition, it has been reported that diabetes predisposes patients for SSI as the glucose level in the blood diminishes immune function [17,19,20].…”

“…Class IV dirty/infected Class I or II (clean or clean-contaminated); Class III or IV (contaminated or dirty/infected) ASA class 16 1. ASA 1 (no disturb) 2.…”

“…Several risk factors have been identified as significant SSI predictors in the literature such as male sex [11][12][13][14][15], obesity [16], diabetes [17][18][19][20], tobacco use [21], hypertension [22,23] and corticosteroid use [24]. The development of an SSI may be due to a combination of these factors, some of which are dependent on the surgical staff and hospital settings while others are patient-centric including comorbidities such as hypertension and corticosteroid use [2].…”