Epidemiology and outcomes associated with surgical site infection following bariatric surgery

Background: Surgical site infection (SSI) is a frequent problem complicating bariatric surgery. However, the potential risk factors, risk stratification, and outcomes of SSIs in this patient population remain poorly defined. The aim of this prospective case-control study was to characterize better the risk factors and to improve risk stratification for SSIs following bariatric surgery. Methods: Patients studied had SSI following Roux-en-Y gastric bypass surgery (RYGBS) between November 2006 and March 2009 at Harper University Hospital and were each matched with 3 controls based on type of operative procedure, surgeon, and year of surgery. Thirty-day outcomes included mortality, hospital readmissions, outpatient procedures, and emergency room visits. A scoring system (BULCS score) was compared with the National Nosocomial Infections Surveillance system risk index using logistic regression. Results: In multivariate analysis, duration of surgery (odds ratio [OR], 3.3; 95% confidence interval [CI]: 1.62-6.74), diagnosis of bipolar disorder (OR, 3.341; 95% CI: 1.0-12.27), use of prophylactic antibiotics other than cefazolin (OR, 4.2; 95% CI: 1.47-11.69), and sleep apnea (OR, 1.8; 95% CI: 1.05-2.97) were significantly associated with SSI. Patients with SSI were more likely to have return emergency visits (OR, 4.96; 95% CI: 2.9-8.48), readmission (OR, 6.53; 95% CI: 3.44-12.42), and outpatient procedures following surgery (OR, 4.75; 95% CI: 1.32-17.14) than were controls without SSI. The BULCS score was a stronger predictor of SSI than the National Nosocomial Infections Surveillance system (C-statistic, -0.62 vs 0.55, respectively). Conclusion: SSI following bariatric surgery was associated with receipt of antibiotic prophylaxis other than cefazolin and comorbid conditions including sleep apnea and bipolar disorder. The BULCS score performed favorably as a predictor and risk adjuster for SSI following bariatric surgery. SSI was associated with increased health care resource utilization. Copyright (C) 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.