title: Wound infections in post-bariatric patients undergoing body contouring abdominoplasty: the role of smoking.
abstract: BACKGROUND
  In this prospective study, we followed patients after laparoscopic adjustable gastric banding for morbid obesity who underwent abdominoplasty for body contouring. Our purposes were: 1) to determine if a significant relationship between cigarette smoking and postoperative wound infections existed, 2) the relative risk conferred by cigarettes and 3) a cut-off value for the increased risk.
  
  
  METHODS
  Patients scheduled for body contouring abdominoplasty were considered eligible. We excluded those with ongoing clinical infections, recent antibiotic administration, those within 1 year from their bariatric surgery and those with systemic diseases. Smokers were asked to stop smoking at least 4 weeks before surgery.
  
  
  RESULTS
  Since November 2004, we recruited 60 patients. Postoperative infections were present in 25% (n=15) of patients and 86.7% of these (n=13) were superficial. All except one occurred in smokers (P = 0.0001): 47% of smokers and 3% of nonsmokers developed infections. Significant differences between infections vs infection-free patients were present for the number of cigarettes smoked per day (P<0.001), years of smoking (P< 0.001), overall estimated cigarettes smoked and the number of pack years (P = 0.001). A cut-off value of approximately 62,000 overall estimated cigarettes (8.5 pack years) distinguished between infections vs infection-free patients (6.2% false positives and 7.1% false negatives). Relative risk conferred by smoking was 14 (95% confidence intervals 13.3-16.7).
  
  
  CONCLUSIONS
  The incidence of infections in post-bariatric patients undergoing body contouring abdominoplasties is 25%. The relative risk conferred by smoking was 14 and the cut-off value was 62,000 overall cigarettes (8.5 pack years).
authors.affiliation: Department of General Surgery, University of Tor Vergata in Rome, Italy. ggravante@hotmail.com
authors.forename: G
authors.initials: G
authors.lastname: Gravante
authors.forename: A
authors.initials: A
authors.lastname: Araco
authors.forename: R
authors.initials: R
authors.lastname: Sorge
authors.forename: F
authors.initials: F
authors.lastname: Araco
authors.forename: D
authors.initials: D
authors.lastname: Delogu
authors.forename: V
authors.initials: V
authors.lastname: Cervelli
mesh_terms: D050153:Abdominal Fat / Q000601:surgery*; D000328:Adult; D015897:Comorbidity; D005260:Female; D015391:Gastroplasty; D006801:Humans; D015187:Lipectomy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D011446:Prospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000453:epidemiology*