Thickness of subcutaneous fat as a strong risk factor for wound infections in elective colorectal surgery: impact of prediction using preoperative CT.
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.
Fujii
Takaaki
T
Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan. ftakaaki@med.gunma-u.ac.jp
Tsutsumi
Soichi
S
Matsumoto
Asuka
A
Fukasawa
Takaharu
T
Tabe
Yuichi
Y
Yajima
Reina
R
Asao
Takayuki
T
Kuwano
Hiroyuki
H
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