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Impact of Bariatric Surgery on Unplanned Hospital Admissions for Infection
Tim Cundy1,2, Greg D Gamble3, Elaine Yi4
1Bariatric Surgical Service, Auckland City Hospital, Auckland, New Zealand. t.cundy@auckland.ac.nz.
Insights
Bariatric surgery significantly reduces hospital admissions for skin and soft tissue infections (SSTI), urinary tract, and lower respiratory tract infections. This benefit, particularly for SSTI, is sustained for at least 8 years post-surgery.
Area of Science:
- Medical Science
- Surgical Innovation
- Infectious Disease Management
Background:
- Obesity and type 2 diabetes increase risks for skin and soft tissue infections (SSTI), urinary tract, and lower respiratory tract infections.
- The impact of bariatric surgery on the incidence of these infections is not well-established.
Purpose of the Study:
- To investigate whether bariatric surgery reduces the incidence of hospital admissions for SSTI, urinary tract, and lower respiratory tract infections.
- To compare infection-related admission rates between patients who underwent bariatric surgery and those who did not.
Main Methods:
- A cohort study comparing unplanned hospital admissions over a median of 4.5 years.
- Included patients from a publicly funded bariatric program, analyzing those who underwent surgery versus those who withdrew.
- Focused on a composite outcome of SSTI, urinary tract, or lower respiratory tract infections.
Main Results:
- Patients undergoing bariatric surgery had 60% fewer infection-related admissions (4.3 vs. 12.2 per 100 patient-years).
- Skin and soft tissue infections (SSTI) showed the most significant reduction (p < 0.0001).
- The positive impact of surgery on infection rates was sustained for up to 8 years and independent of age, BMI, diabetes, or smoking status.
Conclusions:
- Bariatric surgery leads to significantly lower hospitalization rates for specific infections compared to non-surgical candidates.
- The reduction in infections, especially SSTI, is substantial and long-lasting.
- Bariatric surgery offers a sustained protective effect against common infections in individuals with obesity and type 2 diabetes.
Purpose:
Both obesity and type 2 diabetes are associated with an increased risk of skin and soft tissue (SSTI), urinary tract, and lower respiratory tract infections but it is not clear whether the incidence of such infections is reduced after bariatric surgery.
Materials And Methods:
In people accepted onto our publicly funded bariatric program, we recorded unplanned admissions to public hospitals over a median follow-up of 4.5 years in those successfully undergoing surgery and in those who withdrew from the program. Rates of admission for the composite outcome (SSTI, urinary tract, or lower respiratory infection) were compared.
Results:
Of 774 people accepted onto the program, 49% underwent surgery. Infections accounted for 27% of unplanned admissions in those not completing surgery and 13% of those who underwent surgery (p < 0.001). The rate of admission was 60% lower in people who underwent surgery than those who did not: 4.3 vs 12.2 per 100 patient-years (P < 0.002), a difference maintained across 8 years' follow-up. The impact of surgery was independent of enrolment age, BMI, or diabetes and smoking status. Of the three types of infection in the composite outcome, SSTI were the most prevalent and showed the greatest reduction (p < 0.0001). The median day stay for infection was 0.5 day less in those who underwent surgery (p < 0.01).
Conclusions:
Hospitalization for these three infectious diseases in people undergoing bariatric surgery was lower than that in people enrolled in the bariatric program but not completing surgery. The effect was greatest for SSTI, and sustained to at least 8 years.
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