title: Obesity decreases perioperative tissue oxygenation.
abstract: BACKGROUND
  Obesity is an important risk factor for surgical site infections. The incidence of surgical wound infections is directly related to tissue perfusion and oxygenation. Fat tissue mass expands without a concomitant increase in blood flow per cell, which might result in a relative hypoperfusion with decreased tissue oxygenation. Consequently, the authors tested the hypotheses that perioperative tissue oxygen tension is reduced in obese surgical patients. Furthermore, they compared the effect of supplemental oxygen administration on tissue oxygenation in obese and nonobese patients.
  
  
  METHODS
  Forty-six patients undergoing major abdominal surgery were assigned to one of two groups according to their body mass index: body mass index less than 30 kg/m2 (nonobese) or 30 kg/m2 or greater (obese). Intraoperative oxygen administration was adjusted to arterial oxygen tensions of approximately 150 mmHg and approximately 300 mmHg in random order. Anesthesia technique and perioperative fluid management were standardized. Subcutaneous tissue oxygen tension was measured with a polarographic electrode positioned within a subcutaneous tonometer in the lateral upper arm during surgery, in the recovery room, and on the first postoperative day. Postoperative tissue oxygen was also measured adjacent to the wound. Data were compared with unpaired two-tailed t tests and Wilcoxon rank sum test; P < 0.05 was considered statistically significant.
  
  
  RESULTS
  Intraoperative subcutaneous tissue oxygen tension was significantly less in the obese patients at baseline (36 vs. 57 mmHg; P = 0.002) and with supplemental oxygen administration (47 vs. 76 mmHg; P = 0.014). Immediate postoperative tissue oxygen tension was also significantly less in subcutaneous tissue of the upper arm (43 vs. 54 mmHg; P = 0.011) as well as near the incision (42 vs. 62 mmHg; P = 0.012) in obese patients. In contrast, tissue oxygen tension was comparable in each group on the first postoperative morning.
  
  
  CONCLUSIONS
  Wound and tissue hypoxia were common in obese patients in the perioperative period and most pronounced during surgery. Even with supplemental oxygen tissue, oxygen tension in obese patients was reduced to levels that are associated with a substantial increase in infection risk.
authors.affiliation: Department of Anesthesiology, Washington University, St. Louis, Missouri, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kabon
authors.forename: Angelika
authors.initials: A
authors.lastname: Nagele
authors.forename: Dayakar
authors.initials: D
authors.lastname: Reddy
authors.forename: Chris
authors.initials: C
authors.lastname: Eagon
authors.forename: James W
authors.initials: JW
authors.lastname: Fleshman
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.forename: Andrea
authors.initials: A
authors.lastname: Kurz
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D001794:Blood Pressure; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000378:metabolism*; D010100:Oxygen / Q000008:administration & dosage; D010101:Oxygen Consumption; D011184:Postoperative Period; D012307:Risk Factors
chemical_list: D010100:Oxygen