Department of Surgery, Harbor-UCLA Medical Center, 1000 W. Carson St. F10, Torrance, CA, 90502, USA.
Hernia. 2021 Apr;25(2):337-343. doi: 10.1007/s10029-020-02190-x. Epub 2020 Apr 21.
BMI > 40 kg/m and smoking have been identified as risk factors for surgical site infections (SSIs) after ventral hernia repair, however, the relationship with lower BMI values has not been described. The objective of this study was to analyze the relationship between different BMI thresholds, smoking, and SSI after open ventral hernia repair.
All patients who underwent an elective non-emergent open ventral hernia repair with mesh were extracted from the 2011 to 2016 NSQIP database. Bivariate, multivariate logistic regression, and Classification and Regression Tree (CART) analyses were used.
Of 55,240 patients, 2,620 (4.7%) developed SSIs (superficial: 58.5%, deep:27%, organ-space: 16%). BMI (OR: 1.035; 95% CI:1.03-1.04; p < 0.001) and smoking (OR:1.51; 95% CI:1.37-1.67; p < 0.001) were identified in logistic regression analysis as the two most modifiable risk factors independently associated with SSIs. CART analysis demonstrated that the lowest SSI rate belonged to non-smokers with BMI < 24.2 kg/m (1.9%), and the highest SSI to smokers with BMI > 42.3 kg/m (12%). Between these values, there was a stepwise increase in SSI rate as BMI increased, while smoking added additional risk in each group.
Following open hernia repair, the association between SSI and being overweight starts at a BMI of 24.2, a threshold lower than previously described. The risk of SSI increases in a stepwise fashion as BMI increases and is augmented by smoking. Future studies are needed to determine if SSI reduction can be achieved with a combination of smoking cessation and weight loss using these BMI thresholds.
体重指数（BMI）>40kg/m2 和吸烟已被确定为腹疝修补术后手术部位感染（SSI）的危险因素，然而，BMI 值较低与 SSI 的关系尚未描述。本研究的目的是分析不同 BMI 阈值、吸烟与开放式腹疝修补术后 SSI 的关系。
从 2011 年至 2016 年 NSQIP 数据库中提取所有接受择期非紧急开放式腹疝修补术和网片的患者。采用双变量、多变量逻辑回归和分类回归树（CART）分析。
在 55240 例患者中，有 2620 例（4.7%）发生 SSI（浅表：58.5%，深部：27%，器官间隙：16%）。BMI（比值比：1.035；95%置信区间：1.03-1.04；p<0.001）和吸烟（比值比：1.51；95%置信区间：1.37-1.67；p<0.001）在逻辑回归分析中被确定为与 SSI 独立相关的两个最可改变的危险因素。CART 分析显示，非吸烟者 BMI<24.2kg/m2 的 SSI 发生率最低（1.9%），而 BMI>42.3kg/m2 的吸烟者 SSI 发生率最高（12%）。在这些数值之间，随着 BMI 的增加，SSI 发生率呈逐步增加，而吸烟在每个组中都增加了额外的风险。
开放式疝修补术后，超重与 SSI 的关联始于 BMI 为 24.2，这一阈值低于之前的描述。随着 BMI 的增加，SSI 的风险呈阶梯式增加，而吸烟则会增加这种风险。需要进一步的研究来确定是否可以通过使用这些 BMI 阈值结合戒烟和减肥来降低 SSI 的发生率。
