title: Thickness of subcutaneous fat as a strong risk factor for wound infections in elective colorectal surgery: impact of prediction using preoperative CT.
abstract: OBJECTIVE
  In this study, we have attempted to identify and assess factors that would be most predictive of postoperative incisional surgical site infection (SSI) in colorectal surgery, including representative markers for nutrition or obesity.
  
  
  METHODS
  152 patients who underwent elective colorectal resection were identified for inclusion in this study. The outcome of interest was incisional SSI. Variables thought to be predictive of incisional SSI, including body mass index (BMI) and the thickness of subcutaneous fat (TSF), were assessed by univariate and multivariate analysis. TSF was evaluated preoperatively using computed tomography (CT).
  
  
  RESULTS
  The study's overall incidence of incisional SSI following a colorectal operation was 29 (19.1%). TSF was independently associated with incisional SSI. While BMI was significantly associated with incisional SSI on univariate analysis, this variable lost its significance on multivariate analysis that included TSF. Other nutritional markers were not significantly associated with the risk of incisional SSI.
  
  
  CONCLUSIONS
  Our results suggest that the risk of incisional SSI increases with obesity, and that the most useful predictor of incisional SSI is TSF, as evaluated by preoperative CT. These findings indicate that CT is useful for the evaluation of TSF and the prediction of the risk of incisional SSI.
authors.affiliation: Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan. ftakaaki@med.gunma-u.ac.jp
authors.forename: Takaaki
authors.initials: T
authors.lastname: Fujii
authors.forename: Soichi
authors.initials: S
authors.lastname: Tsutsumi
authors.forename: Asuka
authors.initials: A
authors.lastname: Matsumoto
authors.forename: Takaharu
authors.initials: T
authors.lastname: Fukasawa
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Tabe
authors.forename: Reina
authors.initials: R
authors.lastname: Yajima
authors.forename: Takayuki
authors.initials: T
authors.lastname: Asao
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015992:Body Mass Index; D015331:Cohort Studies; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000379:methods; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011300:Preoperative Care; D018570:Risk Assessment; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome