Postoperative bariatric surgery (BS) infection rates (IRs) of 1%‐16.5% have been reported, with a mortality rate of up to 21.7%. This study investigated the 30‐day postoperative IR and mortality rate at our institution. It also examined epidemiologic risk factors for postoperative bariatric surgery infections.
Nosocomial infections that occurred less than 30 days post‐BS at our institution over 6 years were retrospectively reviewed (1 month follow‐up rates of at least 95.4%). Surgical site infection was defined according to the National Nosocomial Infections Surveillance System (NNIS) criteria. Data were collected on all patients with culture‐positive infections. A case‐control study with 70 cases and 280 randomly selected controls was conducted to assess the association of post‐BS infection with age, sex, race/ethnicity, diabetes mellitus (DM), hypertension (HTN), and smoking.
During the period reviewed 4704 bariatric surgeries were performed, of which 74.6% were open gastric bypass (GB) and 25.4% were laparoscopic (LB). Seventy cases (1.5%) with infection were reported — 30 superficial abdominal (42.9%), 12 deep abdominal (17.1%), and 28 intra‐abdominal (40.1%). Mean age of the patients was 49.6 ± 8.9 years, 64.3% were female, and 84.3% were white; mean BMI was 52.6 ± 7.9, 30% had diabetes, 60% were hypertensive, and 15.8% were smokers. Regarding NNIS risk score, 88.6% of the cases and 58.9% of the controls (uninfected) had a risk score of 1, and 11.4% of the cases and 16.6% of the controls had a risk score of 2 (P = .03). Only 2 cases underwent LB bariatric surgery. All patients received local and systemic antibiotics prior to BS. The most commonly cultured organisms were Staphylococcus aureus (52.9%), streptococcus (21.4%), corynebacterium (14.3%), enterococcus (11.4%), and Proteus mirabilis (11.4%). Forty‐one cases (58.6%) had incision and drainage, 25 (35.7%) exploratory laparotomy, and 2 (2.9%) acute respiratory distress syndrome. Infection‐related mortality was 2.9% (n = 2), and overall mortality was 0.04%. Mean length of hospital stay for cases was 6.71 days versus 3.09 days for uninfected (control) patients. There was a significant association of length of stay with age (P = .04) and HTN (P = .01) in the linear regression model. A multiple logistic regression model showed that those who were elderly (adjusted OR = 1.08, 95% CI: 1.04‐1.11, P < .0001) and those who were male (adjusted OR = 0.45, 95% CI: 0.25‐0.80, P = .006) were significantly more likely to develop post‐BS infections.
Hospitalists play a key role in the perioperative management of BS; hence, knowledge of factors involved in postoperative infections is imperative. Thirty‐day IR (1.5%) and infection‐related mortality (2.9%) after BS were low at our institution, possibly because of the low NNIS risk scores (58.9% had a score of 1), compliance with preoperative local and systemic antibiotics, a no‐shave policy, and surgical expertise. In our case‐control analysis, only age and sex had a statistically significant association with post‐BS infections; history of DM, HTN, and smoking did not.
R. Sahni, None; P. Sharma, None; N. Rohatgi, None; R. Chmielewski, None.
To cite this abstract:Sahni R, Sharma P, Rohatgi N, Chmielewski R. Nosocomial Infections in Patients after Undergoing Bariatric Surgery at Our Institution. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 55. https://www.shmabstracts.com/abstract/nosocomial-infections-in-patients-after-undergoing-bariatric-surgery-at-our-institution/. Accessed December 10, 2018.