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Surgical site infection and analytic morphometric assessment of body composition in patients undergoing midline
Jay S Lee1, Michael N Terjimanian, Lindsay M Tishberg
1Center for Analytic Morphomics and the Summer Student Research Program, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Background:
Obesity is a known risk factor for surgical site infection (SSI). Our hypothesis is that morphometric measures of midline subcutaneous fat will be associated with increased risk of SSI and will predict SSI better than conventional measures of obesity.
Study Design:
We identified 655 patients who underwent midline laparotomy (2006 to 2009) using the Michigan Surgical Quality Collaborative database. Using novel, semiautomated analytic morphometric techniques, the thickness of subcutaneous fat along the linea alba was measured between T12 and L4. To adjust for variations in patient size, subcutaneous fat was normalized to the distance between the vertebrae and anterior skin. Logistic regression analyses were used to identify factors independently associated with the incidence of SSI.
Results:
Overall, SSIs were observed in 12.5% (n = 82) of the population. Logistic regression revealed that patients with increased subcutaneous fat had significantly greater odds of developing a superficial incisional SSI (odds ratio [OR] = 1.76 per 10% increase, 95% CI 1.10 to 2.83, p = 0.019). Smoking, steroid use, American Society of Anesthesiologists (ASA) classification, and incision-to-close operative time were also significant independent risk factors for superficial incisional SSI. When comparing subcutaneous fat and body mass index (BMI) as the only model variables, subcutaneous fat significantly improved model predictions of superficial incisional SSI (area under the receiver operating characteristic curve [AUC] 0.60, p = 0.023); BMI did not (AUC 0.52, p = 0.73).
Conclusions:
Abdominal subcutaneous fat is an independent predictor of superficial incisional SSI after midline laparotomy. Novel morphometric measures may improve risk stratification and help elucidate the pathophysiology of surgical complications.
Insights
Increased abdominal subcutaneous fat is linked to a higher risk of surgical site infections (SSI) after midline laparotomy. Morphometric fat measurements better predict SSI than body mass index (BMI).
Area of Science:
- Surgical outcomes research
- Medical imaging and analysis
- Obesity and metabolic disease
Background:
- Obesity is a recognized risk factor for surgical site infections (SSI).
- Conventional obesity measures may not fully capture SSI risk.
- Subcutaneous fat may play a distinct role in SSI development.
Purpose of the Study:
- To investigate the association between morphometric measures of abdominal subcutaneous fat and SSI risk.
- To compare the predictive ability of subcutaneous fat measurements versus body mass index (BMI) for SSI.
- To identify novel predictors for surgical complications.
Main Methods:
- Analysis of 655 patients undergoing midline laparotomy from 2006-2009.
- Semiautomated morphometric techniques to measure midline subcutaneous fat thickness.
- Logistic regression to identify independent risk factors for SSI, adjusting for patient size.
Main Results:
- A 12.5% incidence of SSI was observed.
- Increased subcutaneous fat was significantly associated with higher odds of superficial incisional SSI (OR = 1.76 per 10% increase).
- Subcutaneous fat measurements improved SSI prediction compared to BMI (AUC 0.60 vs. 0.52).
Conclusions:
- Abdominal subcutaneous fat is an independent predictor of superficial incisional SSI following midline laparotomy.
- Novel morphometric fat measurements offer improved risk stratification for surgical complications.
- Understanding fat distribution may elucidate SSI pathophysiology.
