Winfield Robert D, Reese Stacey, Bochicchio Kelly, Mazuski John E, Bochicchio Grant V
Department of Surgery, Section of Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Am Surg. 2016 Apr;82(4):331-6.
Obesity is a risk factor for surgical site infection (SSI) after abdominal procedures; however, data characterizing the risk of SSI in obese patients during abdominal procedures are lacking. We hypothesized that obesity is an independent risk factor for SSI across wound classes. We analyzed American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data for 2011. We calculated body mass index (BMI), classifying patients according to National Institute of Health (NIH) BMI groups. We excluded records in which height/weight was not recorded and patients with BMI less than 18.5. We examined patients undergoing open abdominal procedures, performing univariate and multivariate analyses to assess the relative contribution of obesity to SSI. Study criteria were met by 89,148 patients. Obese and morbidly obese patients had significantly greater SSI rates in clean and clean-contaminated cases but not contaminated or dirty/infected cases. Logistic regression confirmed obesity and morbid obesity as being independently associated with the overall SSI development, specifically in clean [Obesity odds ratio (OR) = 1.757, morbid obesity OR = 2.544, P < 0.001] and clean-contaminated (obesity OR = 1.239, morbid obesity OR = 1.287, P < 0.001) cases. Obesity is associated with increased risk of SSI overall, specifically in clean and clean-contaminated abdominal procedures; this is independent of diabetes mellitus. Novel techniques are needed to reduce SSI in this high-risk patient population.
肥胖是腹部手术后手术部位感染（SSI）的一个风险因素；然而，目前缺乏关于肥胖患者在腹部手术期间发生SSI风险特征的数据。我们假设肥胖是各类伤口手术部位感染的独立风险因素。我们分析了美国外科医师学会国家外科质量改进计划（ACS - NSQIP）2011年的数据。我们计算了体重指数（BMI），并根据美国国立卫生研究院（NIH）的BMI分组对患者进行分类。我们排除了未记录身高/体重的记录以及BMI小于18.5的患者。我们研究了接受开放性腹部手术的患者，进行单因素和多因素分析以评估肥胖对SSI的相对影响。共有89148名患者符合研究标准。在清洁和清洁 - 污染手术病例中，肥胖和病态肥胖患者的SSI发生率显著更高，但在污染或脏污/感染手术病例中并非如此。逻辑回归证实肥胖和病态肥胖与总体SSI的发生独立相关，特别是在清洁手术中（肥胖优势比（OR）= 1.757，病态肥胖OR = 2.544，P < 0.001）和清洁 - 污染手术中（肥胖OR = 1.239，病态肥胖OR = 1.287，P < 0.001）。肥胖总体上与SSI风险增加相关，特别是在清洁和清洁 - 污染的腹部手术中；这与糖尿病无关。需要新的技术来降低这一高危患者群体的SSI发生率。
