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

Anouk P Meijs¹, Mayke B G Koek¹, Margreet C Vos²

¹Department of Epidemiology and Surveillance, Centre for Infectious Disease Control (CIb),National Institute for Public Health and the Environment (RIVM),Bilthoven,The Netherlands.

Infection Control and Hospital Epidemiology

|June 25, 2019

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.

Insights

Higher body mass index (BMI) significantly increases the risk of surgical site infections (SSI). Morbidly obese patients face the highest risk, underscoring the need for targeted prevention strategies.

Area of Science:

Surgical Infection Prevention
Obesity and Health Outcomes
Public Health Surveillance

Background:

Surgical site infections (SSIs) are a significant concern in healthcare.
Obesity is a known risk factor for various surgical complications.
Quantifying the precise impact of body mass index (BMI) on SSI risk is crucial for targeted interventions.

Purpose of the Study:

To evaluate the association between different body mass index (BMI) categories and the risk of surgical site infections (SSIs).
To analyze the impact of BMI on superficial, deep, and total SSIs across diverse surgical procedures.

Main Methods:

Utilized data from the Dutch national surveillance network PREZIES (2012-2017).
Included nearly 400,000 patients undergoing various surgical procedures.
Employed multilevel log binomial regression to analyze BMI category effects on SSI risk.

Main Results:

A clear trend of increasing SSI risk with rising BMI (overweight to morbidly obese) was observed across most procedures.
Morbidly obese patients showed the most profound increase in risk, particularly for deep SSIs in procedures like total hip prosthesis (RR up to 7.8).
The impact of BMI on SSI risk varied by wound type and surgical specialty, with clean wounds and certain procedures showing higher susceptibility.

Conclusions:

Findings support the necessity of implementing preventive programs specifically for overweight and obese surgical patients.
Public health initiatives aimed at obesity prevention in the general population are also recommended.
BMI stratification is essential for risk assessment and management in surgical settings.

Read full analysis

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