Prevalence and Risk Factors of postoperative wound infection in obese surgical candidates

Fionn Nolan; O. Kelly; N. Byrne

doi:10.5281/zenodo.22813509

Authors

Fionn Nolan Division of General Surgery, Brahmaputra Academy of General Surgery Author https://orcid.org/8123-8555-8792-9426
O. Kelly Department of Surgical Research, Euphrates Institute of Surgical Research Author https://orcid.org/9189-9938-2429-7049
N. Byrne Department of Clinical General Surgery, Dnieper Center for Surgical Research Author https://orcid.org/5307-8750-0582-3557

DOI:

https://doi.org/10.5281/zenodo.22813509

Keywords:

surgical site infection, obesity, risk factors, wound infection, general surgery

Abstract

Graphical abstract

Background: Obesity is a well-recognised driver of surgical site infection (SSI), but the magnitude of risk and the relative contribution of modifiable versus non-modifiable factors vary widely across surgical populations and remain incompletely characterised in general surgical cohorts.

Objective: To determine the prevalence of postoperative wound infection among obese patients undergoing elective and emergency general surgery and to identify independent risk factors for SSI in this population.

Methods: A prospective observational cohort of adult patients with a body mass index of 30 kg/m2 or higher undergoing general surgical procedures was followed from admission through 30 days postoperatively. Wound status was assessed using Centers for Disease Control and Prevention surveillance criteria, and candidate predictors were evaluated by multivariable logistic regression.

Results: Surgical site infection occurred in a substantial minority of obese patients, with prevalence rising progressively across body mass index strata and among patients with diabetes mellitus, longer operative duration, contaminated or dirty wound class, current smoking, and emergency admission. Multivariable analysis identified body mass index of 35 kg/m2 or higher, diabetes mellitus, operative time exceeding two hours, and wound class III-IV as independent predictors of infection.

Conclusion: Postoperative wound infection remains common among obese surgical candidates and clusters around a small set of identifiable, partly modifiable risk factors. Targeted perioperative optimisation of glycaemic control, tissue oxygenation, antibiotic prophylaxis timing, and operative efficiency in higher-risk obese subgroups may reduce this burden.

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