“…15,28,35,37 Obesity has further been associated with mixed flora infections in patients undergoing spinal fusion, which have a higher risk of relapse after medical management, requiring prolonged antibiotic courses to clear the SSI if medical management is even successful. 35,36 Furthermore, previous literature has shown that obesity is a paradoxical state of malnutrition, where despite a positive energy balance and potentially significant adiposity, obese patients are frequently severely deficient in crucial micronutrients required for proper wound healing. 38 In adults undergoing PSF, up to 40% of those with SSI have evidence of clinically significant malnutrition, and malnutrition has been directly linked with a heightened risk of SSI after PSF, as well as significant increases in incision morbidity, length of hospitalization, and 1-year mortality.…”