Obesity increases a patient’s risk for developing a surgical site infection, or SSI, although the extent of impact depends on the type of surgery, according to a recent study conducted in the Netherlands.
“The prevalence of obesity is growing worldwide and is reaching epidemic proportions in developed countries,” Anouk P. Meijs, MSc, from the Centre for Infectious Disease Control in the Netherlands’ National Institute for Public Health and the Environment, and colleagues wrote. “In the Netherlands, the prevalence of obesity” — patients with a body mass index (BMI) of 30 kg/m2 — “has more than doubled from 5% in 1991 to 12% in 2016. Simultaneously, the percentage of overweight persons” — BMI between 25 and 30 kg/m2 — “has increased from 25% to 31%.
“Obesity has been associated with a higher risk of developing diseases such as type 2 diabetes, several cancer types including colon and breast cancer, musculoskeletal disorders, and cardiovascular disease. As patients with these diseases more frequently require surgery, obese patients are becoming an increasingly large subset of surgical patients. Furthermore, being obese is described to result in poorer outcomes in several surgery types and in an increased risk of infectious complications, especially SSI.”
According to the study, Meijs and colleagues quantified the impact of BMI on the risk for SSI for a variety of surgical procedures using data on 387,919 patients from the Dutch national surveillance network PREZIES. They stratified patients into five categories — underweight, normal weight, overweight, obese and morbidly obese and assessed the effect of BMI category on the risk for superficial, deep and total SSIs.
Overall, 1% of patients were underweight, 30% had normal weight, 40% were overweight, 27% had obesity and 2% had morbid obesity. Meijs and colleagues reported finding an increasing risk for SSI when BMI increased from normal to morbidly obese for almost all surgery types, with patients with morbid obesity packing RRs ranging up to 7.8% (95% CI, 6-10.2) for deep SSI in total hip prosthesis.
According to the study, the increase was most significant in surgeries with clean wounds. Chest and abdominal surgeries saw a larger impact for superficial SSI compared with deep SSIs, Meijs and colleagues reported.
“Being obese or morbidly obese increased the chance of developing an SSI after a wide range of surgeries, although the extent of the impact differed per surgery type,” the authors concluded. “Since the average body weight is increasing, the number of obese patients that needs surgical care will grow, especially in clean surgeries. Therefore, increasing attention must be given to the nationwide prevention of overweight and obesity as well as the prevention of SSIs in patients with increased BMI.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.