Percent Body Fat and Prediction of Surgical Site Infection

Emily Waisbren, Heather Rosen, Angela M. Bader, Stuart R. Lipsitz, Selwyn O. Rogers, Elof Eriksson

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

Background: Obesity is a risk factor for surgical site infection (SSI) after elective surgery. Body mass index (BMI) is commonly used to define obesity (BMI ≥30 kg/m2), but percent body fat (%BF) (obesity is >25%BF [men]; >31%BF [women]) might better predict SSI risk because BMI might not reflect body composition. Study Design: This prospective study included 591 elective surgical patients 18 to 64 years of age from September 2008 through February 2009. Height and weight were measured for BMI. %BF was calculated by bioelectrical impedance analysis. Preoperative, operative, and 30-day postoperative data were captured through interviews and chart review. Our primary, predetermined outcomes measurement was SSI as defined by the Center for Disease Control and Prevention. Results: Mean %BF and BMI were 34±10 and 29±8, respectively. Four-hundred and nine (69%) patients were obese by %BF; 225 (38%) were obese by BMI. SSI developed in 71 (12%) patients. With BMI defining obesity, SSI incidence was 12.3% in nonobese and 11.6% in obese patients (p = 0.8); Using %BF, SSI occurred in 5.0% of nonobese and 15.2% of obese patients (p < 0.001). In univariate analyses, significant predictors of SSI were %BF (p = 0.005), obesity by %BF (p < 0.001), smoking (p = 0.002), National Nosocomial Infections Surveillance score (p < 0.001), postoperative hyperglycemia (p = 0.03), and anemia (p = 0.02). In multivariable analysis, obese patients by %BF had a 5-fold higher risk for SSI than nonobese patients (odds ratio = 5.3; 95% CI, 1.2-23.1; p = 0.03). Linear regression was used to show that there is a positive, nonlinear relationship between %BF and BMI. Conclusions: Obesity, defined by %BF, is associated with a 5-fold increased SSI risk. This risk increases as %BF increases. %BF is a more sensitive and precise measurement of SSI risk than BMI. Additional studies are required to better understand this relationship.

Original languageEnglish (US)
Pages (from-to)381-389
Number of pages9
JournalJournal of the American College of Surgeons
Volume210
Issue number4
DOIs
StatePublished - Apr 2010
Externally publishedYes

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Surgical Wound Infection
Adipose Tissue
Body Mass Index
Obesity
Centers for Disease Control and Prevention (U.S.)
Cross Infection
Body Composition
Electric Impedance
Hyperglycemia
Anemia
Linear Models
Smoking
Odds Ratio
Prospective Studies
Interviews

ASJC Scopus subject areas

  • Surgery

Cite this

Waisbren, E., Rosen, H., Bader, A. M., Lipsitz, S. R., Rogers, S. O., & Eriksson, E. (2010). Percent Body Fat and Prediction of Surgical Site Infection. Journal of the American College of Surgeons, 210(4), 381-389. https://doi.org/10.1016/j.jamcollsurg.2010.01.004

Percent Body Fat and Prediction of Surgical Site Infection. / Waisbren, Emily; Rosen, Heather; Bader, Angela M.; Lipsitz, Stuart R.; Rogers, Selwyn O.; Eriksson, Elof.

In: Journal of the American College of Surgeons, Vol. 210, No. 4, 04.2010, p. 381-389.

Research output: Contribution to journalArticle

Waisbren, E, Rosen, H, Bader, AM, Lipsitz, SR, Rogers, SO & Eriksson, E 2010, 'Percent Body Fat and Prediction of Surgical Site Infection', Journal of the American College of Surgeons, vol. 210, no. 4, pp. 381-389. https://doi.org/10.1016/j.jamcollsurg.2010.01.004
Waisbren, Emily ; Rosen, Heather ; Bader, Angela M. ; Lipsitz, Stuart R. ; Rogers, Selwyn O. ; Eriksson, Elof. / Percent Body Fat and Prediction of Surgical Site Infection. In: Journal of the American College of Surgeons. 2010 ; Vol. 210, No. 4. pp. 381-389.
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abstract = "Background: Obesity is a risk factor for surgical site infection (SSI) after elective surgery. Body mass index (BMI) is commonly used to define obesity (BMI ≥30 kg/m2), but percent body fat ({\%}BF) (obesity is >25{\%}BF [men]; >31{\%}BF [women]) might better predict SSI risk because BMI might not reflect body composition. Study Design: This prospective study included 591 elective surgical patients 18 to 64 years of age from September 2008 through February 2009. Height and weight were measured for BMI. {\%}BF was calculated by bioelectrical impedance analysis. Preoperative, operative, and 30-day postoperative data were captured through interviews and chart review. Our primary, predetermined outcomes measurement was SSI as defined by the Center for Disease Control and Prevention. Results: Mean {\%}BF and BMI were 34±10 and 29±8, respectively. Four-hundred and nine (69{\%}) patients were obese by {\%}BF; 225 (38{\%}) were obese by BMI. SSI developed in 71 (12{\%}) patients. With BMI defining obesity, SSI incidence was 12.3{\%} in nonobese and 11.6{\%} in obese patients (p = 0.8); Using {\%}BF, SSI occurred in 5.0{\%} of nonobese and 15.2{\%} of obese patients (p < 0.001). In univariate analyses, significant predictors of SSI were {\%}BF (p = 0.005), obesity by {\%}BF (p < 0.001), smoking (p = 0.002), National Nosocomial Infections Surveillance score (p < 0.001), postoperative hyperglycemia (p = 0.03), and anemia (p = 0.02). In multivariable analysis, obese patients by {\%}BF had a 5-fold higher risk for SSI than nonobese patients (odds ratio = 5.3; 95{\%} CI, 1.2-23.1; p = 0.03). Linear regression was used to show that there is a positive, nonlinear relationship between {\%}BF and BMI. Conclusions: Obesity, defined by {\%}BF, is associated with a 5-fold increased SSI risk. This risk increases as {\%}BF increases. {\%}BF is a more sensitive and precise measurement of SSI risk than BMI. Additional studies are required to better understand this relationship.",
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N2 - Background: Obesity is a risk factor for surgical site infection (SSI) after elective surgery. Body mass index (BMI) is commonly used to define obesity (BMI ≥30 kg/m2), but percent body fat (%BF) (obesity is >25%BF [men]; >31%BF [women]) might better predict SSI risk because BMI might not reflect body composition. Study Design: This prospective study included 591 elective surgical patients 18 to 64 years of age from September 2008 through February 2009. Height and weight were measured for BMI. %BF was calculated by bioelectrical impedance analysis. Preoperative, operative, and 30-day postoperative data were captured through interviews and chart review. Our primary, predetermined outcomes measurement was SSI as defined by the Center for Disease Control and Prevention. Results: Mean %BF and BMI were 34±10 and 29±8, respectively. Four-hundred and nine (69%) patients were obese by %BF; 225 (38%) were obese by BMI. SSI developed in 71 (12%) patients. With BMI defining obesity, SSI incidence was 12.3% in nonobese and 11.6% in obese patients (p = 0.8); Using %BF, SSI occurred in 5.0% of nonobese and 15.2% of obese patients (p < 0.001). In univariate analyses, significant predictors of SSI were %BF (p = 0.005), obesity by %BF (p < 0.001), smoking (p = 0.002), National Nosocomial Infections Surveillance score (p < 0.001), postoperative hyperglycemia (p = 0.03), and anemia (p = 0.02). In multivariable analysis, obese patients by %BF had a 5-fold higher risk for SSI than nonobese patients (odds ratio = 5.3; 95% CI, 1.2-23.1; p = 0.03). Linear regression was used to show that there is a positive, nonlinear relationship between %BF and BMI. Conclusions: Obesity, defined by %BF, is associated with a 5-fold increased SSI risk. This risk increases as %BF increases. %BF is a more sensitive and precise measurement of SSI risk than BMI. Additional studies are required to better understand this relationship.

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