Hostname: page-component-669899f699-rg895 Total loading time: 0 Render date: 2025-04-24T12:23:56.918Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  24 June 2019

Anouk P. Meijs ,
Mayke B.G. Koek ,
Margreet C. Vos ,
Suzanne E. Geerlings ,
H. Charles Vogely  and
Sabine C. de Greeff
Anouk P. Meijs*
Affiliation:
Department of Epidemiology and Surveillance, Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Mayke B.G. Koek
Affiliation:
Department of Epidemiology and Surveillance, Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Margreet C. Vos
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
Suzanne E. Geerlings
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Center, The Netherlands
H. Charles Vogely
Affiliation:
Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
Sabine C. de Greeff
Affiliation:
Department of Epidemiology and Surveillance, Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
*
Author for correspondence: Anouk P. Meijs, Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 9 , September 2019 , pp. 991 - 996
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Ng, M, Flemming, T, Robinson, M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384:766–781.CrossRefGoogle ScholarPubMed
CBS StatLine. Lengte en gewicht van personen, ondergewicht en overgewicht; vanaf 1981. CBS Statline website. http://statline.cbs.nl/StatWeb/publication/?DM%3dSLNL&PA%3d81565NED. Published July 4, 2018. Accessed December 1, 2018.Google Scholar
Suleiman, LI, Ortega, G, Ong’uti, SK, et al. Does BMI affect perioperative complications following total knee and hip arthroplasty? J Surg Res 2012;174:7–11.CrossRefGoogle ScholarPubMed
Al-Mulhim, AS, Al-Hussaini, HA, Al-Jalal, BA, Al-Moagal, RO, Al-Naijar, SA. Obesity disease and surgery. Int J Chronic Dis 2014;2014:652341.Google ScholarPubMed
Huttunen, R, Syrjanen, J. Obesity and the risk and outcome of infection. Int J Obes (Lond) 2013;37:333–340.CrossRefGoogle Scholar
Pi-Sunyer, X. The medical risks of obesity. Postgrad Med 2009;121:21–33.CrossRefGoogle ScholarPubMed
Guh, DP, Zhang, W, Bansback, N, Amarsi, Z, Birmingham, CL, Anis, AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009;9:88.Google ScholarPubMed
CDB 2015 Obesity Collaborators, Afshin, A, Forouzanfar, MH, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 2017;377:13–27.Google ScholarPubMed
Lauby-Secretan, B, Scoccianti, C, Loomis, D, et al. Body fatness and cancer—viewpoint of the IARC Working Group. N Engl J Med 2016;375:794–798.CrossRefGoogle ScholarPubMed
Anaya, DA, Dellinger, EP. The obese surgical patient: a susceptible host for infection. Surg Infect (Larchmt) 2006;7:473–480.CrossRefGoogle ScholarPubMed
Huttunen, R, Karppelin, M, Syrjanen, J. Obesity and nosocomial infections. J Hosp Infect 2013;85:8–16.Google ScholarPubMed
Canturk, Z, Canturk, NZ, Cetinarslan, B, Utkan, NZ, Tarkun, I. Nosocomial infections and obesity in surgical patients. Obes Res 2003;11:769–775.CrossRefGoogle ScholarPubMed
Gao, M, Sun, J, Young, N, et al. Impact of body mass index on outcomes in cardiac surgery. J Cardiothorac Vasc Anesth 2016;30:1308–1316.CrossRefGoogle ScholarPubMed
Tong, DK, Fan, JK, Law, WL, Outcome of laparoscopic colorectal resection. Surgeon 2008;6:357–360.CrossRefGoogle ScholarPubMed
Lujan, JA, Frutos, MD, Hernandez, Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg 2004;239:433–437.CrossRefGoogle ScholarPubMed
Makino, T, Shukla, PJ, Rubino, F, Milsom, JW. The impact of obesity on perioperative outcomes after laparoscopic colorectal resection. Ann Surg 2012;255:228–236.CrossRefGoogle ScholarPubMed
Segal, CG, Waller, DK, Tilley, B, Piller, L, Bilimoria, K. An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery. Surgery 2014;156:1253–1260.CrossRefGoogle ScholarPubMed
Winfield, RD, Reese, S, Bochicchio, K, Mazuski, JE, Bochicchio, GV. Obesity and the risk for surgical site infection in abdominal surgery. Am Surg 2016;82:331–336.Google ScholarPubMed
Thelwall, S, Harrington, P, Sheridan, E, Lamagni, T. Impact of obesity on the risk of wound infection following surgery: results from a nationwide prospective multicentre cohort study in England. Clin Microbiol Infect 2015;21:1008.e1–e8.CrossRefGoogle ScholarPubMed
Gurunathan, U, Ramsay, S, Mitric, G, Way, M, Wockner, L, Myles, P. Association between obesity and wound infection following colorectal surgery: systematic review and meta-analysis. J Gastrointest Surg 2017;21:1700–1712.CrossRefGoogle ScholarPubMed
Nashef, SA, Roques, F, Michel, P, Gauducheau, E, Lemeshow, S, Salamon, R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999;16:9–13.CrossRefGoogle Scholar
Nashef, SAM, Roques, F, Sharples, LD, et al. EuroSCORE II. Eur J Cardiothorac Surg 2012;41:734–745.Google ScholarPubMed
Koek, MBG, Hopmans, TEM, Soetens, LC, et al. Adhering to a national surgical care bundle reduces the risk of surgical site infections. PLoS One 2017;12:e0184200.CrossRefGoogle ScholarPubMed
Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
Surveillance of surgical site infections in European hospitals—HAISSI protocol. Version 1.02. European Centre for Disease Prevention and Control (ECDC) website. http://www.ecdc.europa.eu/en/publications/Publications/120215_TED_SSI_Protocol.pdf. Published 2012. Accessed June 3, 2019.Google Scholar
Verberk, JDM, Meijs, AP, Vos, MC, et al. Contribution of prior, multiple-, and repetitive surgeries to the risk of surgical site infections in the Netherlands. Infect Control Hosp Epidemiol 2017;38:1298–1305.CrossRefGoogle ScholarPubMed
Guo, S, Dipietro, LA. Factors affecting wound healing. J Dent Res 2010;89:219–229.CrossRefGoogle ScholarPubMed
Dobner, J, Kaser, S. Body mass index and the risk of infection—from underweight to obesity. Clin Microbiol Infect. 2018;24:24–28.CrossRefGoogle Scholar
Cho, M, Kang, J, Kim, IK, Lee, KY, Sohn, SK. Underweight body mass index as a predictive factor for surgical site infections after laparoscopic appendectomy. Yonsei Med J 2014;55:1611–1616.CrossRefGoogle ScholarPubMed
Martin, ET, Kaye, JS, Knott, C, Nguyen, H, et al. Diabetes and risk of surgical site infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2016;37:88–99.CrossRefGoogle ScholarPubMed
Omar, AS, Salama, A, Allam, M, et al. Association of time in blood glucose range with outcomes following cardiac surgery. BMC Anesthesiol 2015;15:14.CrossRefGoogle ScholarPubMed
Braga, M, Vignali, A, Gianotti, , et al. Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 2002;236:759–767.CrossRefGoogle ScholarPubMed
Lascano, CA, Kaidar-Person, O, Szomstein, S, Rosenthal, R, Wexner, SD. Challenges of laparoscopic colectomy in the obese patient: a review. Am J Surg 2006;192:357–365.CrossRefGoogle ScholarPubMed
Belizon, A, Sardinha, CT, Sher, ME, Converted laparoscopic colectomy: what are the consequences? Surg Endosc 2006;20:947–951.CrossRefGoogle ScholarPubMed
Fujii, T, Tsutsumi, S, Matsumoto, A, et al. Thickness of subcutaneous fat as a strong risk factor for wound infections in elective colorectal surgery: impact of prediction using preoperative CT. Dig Surg 2010;27:331–335.CrossRefGoogle ScholarPubMed
Lee, JS, Terjimanian, MN, Tishberg, LM, et al. Surgical site infection and analytic morphometric assessment of body composition in patients undergoing midline laparotomy. J Am Coll Surg 2011;213:236–244.Google ScholarPubMed
Workgroup of the American Association of Hip and Knee Surgeons Evidence Based Committee. Obesity and total joint arthroplasty: a literature based review. J Arthroplasty 2013;28:714–721.CrossRefGoogle Scholar
Kotsis, V, Tsioufis, K, Antza, C, et al. Obesity and cardiovascular risk: a call for action from the European Society of Hypertension Working Group of Obesity, Diabetes and the High-risk Patient and European Association for the Study of Obesity: part B: obesity-induced cardiovascular disease, early prevention strategies and future research directions. J Hypertens 2018;36:1441–1455.CrossRefGoogle Scholar
van den Berghe, G, Wouters, P, Weekers, F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359–1367.Google ScholarPubMed
Supplementary material: File

Meijs et al. supplementary material

Table S1

Download Meijs et al. supplementary material(File)
File 25.6 KB