Jerry T Dang, MD1, Caroline Tran2, Megan Delisle, MD3, Noah Switzer, MD, MPH4, Michael Laffin, MD, PhD1, Karen Madsen, PhD1, Daniel Birch, MD, MSc1, Shahzeer Karmali, MD, MPH1. 1University of Alberta, 2Centre for the Advancement of Minimally Invasive Surgery, 3University of Manitoba, 4Ohio State University
Introduction: The objective of this study was to develop a predictive tool for incisional surgical site infection (SSI) within 30 days of bariatric surgery. Although bariatric surgery is a safe and effective procedure for severe obesity, SSI remains a significant cause of morbidity. Bariatric surgery patients are at higher risk due to obesity and a higher prevalence of diabetes. The rate of SSI in bariatric surgery ranges from 1.4 to 30% which varies depending on type of bariatric procedure and technique.
Methods and Procedures: Data were retrieved from the 2015 and 2016 MBSAQIP participant use files. This study included patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) and excluded patients under 18 years of age, who had previous bariatric or foregut surgery, and those undergoing emergency surgery. Patients with a SSI prior to surgery were also excluded. The primary outcome of interest was incisional SSI occurring within 30 days of the principal operation.
Surgeries performed in 2015 were used in a derivation cohort and the predictive tool was validated against the 2016 cohort. A forward selection algorithm with an entry p-value of < 0.01 was used to build a logistic regression model predicting probability of incisional SSI within 30 days using the derivation data set.
Results: A total of 274,187 patients from 791 centers were included in this analysis with 196,608 (71.7%) SG and 77,579 (28.3%) RYGB. 1,841 patients had a SSI (0.7%) in which 70.1% had an incisional SSI, 29.0% had an organ/space SSI and 0.9% had a combined incisional and organ/space SSI. Of patients who had an incisional SSI, 88.7% were superficial, 10.9% were deep and 0.4% were both[ML1] .
A prediction model to assess for risk of incisional SSI, BariWound, was derived and validated. BariWound consists of: procedure type, chronic steroid use, gastroesophageal reflux disease, obstructive sleep apnea, sex, type 2 diabetes, hypertension, operative time, and body mass index. It stratifies individuals into very high (>10%), high (5-10%), medium (1-5%), and low risk groups (<1%). This model accurately predicted events in the validation cohort with an area under the receiver operating characteristic curve of 0.73.
Conclusions: BariWound is a tool that accurately predicts the risk of 30-day incisional SSI in individuals undergoing bariatric surgery. Stratifying low- and high-risk groups allows for customized SSI prophylactic measures for patients in various risk categories and potentially enables future research targeted at low- and high-risk populations.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94113
Program Number: S050
Presentation Session: Bariatric I – Complications
Presentation Type: Podium