title: Obesity in regional anesthesia--a risk factor for peripheral catheter-related infections.
abstract: BACKGROUND
  Obesity is believed to increase the risk of surgical site infections and possibly increase the risk of catheter-related infections in regional anesthesia. We, therefore, analyzed the influence of obesity on catheter-related infections defined within a national registry for regional anesthesia.
  
  
  METHODS
  The German Network for Regional Anesthesia database with 25 participating clinical centers was analyzed between 2007 and 2012. Exactly, 28,249 cases (13,239 peripheral nerve and 15,010 neuraxial blocks) of patients ≥ 14 years were grouped in I: underweight (BMI 13.2-18.49 kg/m(2) , n = 597), II: normal weight (BMI 18.5-24.9 kg/m(2) , n = 9272), III: overweight (BMI 25.0-29.9 kg/m(2) , n = 10,632), and IV: obese (BMI 30.0-70.3 kg/m(2) , n = 7,744). The analysis focused on peripheral and neuraxial catheter-related infections. Differences between the groups were tested with non-parametric ANOVA and chi-square (P < 0.05). Binary logistic regression was used to compare obese, overweight, or underweight patients with normal weight patients. Odds ratios (OR and 95% confidence interval) were calculated and adjusted for potential confounders.
  
  
  RESULTS
  Confounders with significant influence on the risk for catheter-related infections were gender, age, ASA score, diabetes, preoperative infection, multiple skin puncture, and prolonged catheter use. The incidence (normal weight: 2.1%, obese: 3.6%; P < 0.001) and the risk of peripheral catheter-related infection was increased in obese compared to normal weight patients [adjusted OR: 1.69 (1.25-2.28); P < 0.001]. In neuraxial sites, the incidence of catheter-related infections differed significantly between normal weight and obese patients (normal weight: 3.2%, obese: 2.3%; P = 0.01), whereas the risk was comparable [adjusted OR: 0.95 (0.71-1.28); P = 0.92].
  
  
  CONCLUSIONS
  This retrospective cohort study suggests that obesity is an independent risk factor for peripheral, but not neuraxial, catheter-related infections.
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University of Saarland, Saarland University Medical Center, Homburg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Bomberg
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University of Saarland, Saarland University Medical Center, Homburg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Albert
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University of Saarland, Saarland University Medical Center, Homburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Schmitt
authors.affiliation: Department of Biostatistics and Medical Informatics, Institute for Epidemiology, University of Saarland, Saarland University Medical Center, Homburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Gräber
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, Orthopedic University Hospital, Frankfurt, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Kessler
authors.affiliation: Department of Anesthesiology and Intensive Care Therapy, Philipps University Marburg, Marburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Steinfeldt
authors.affiliation: Department of Anesthesiology, St. Marien-Krankenhaus Siegen, Siegen, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Hering
authors.affiliation: Department of Anesthesiology, Intensive Care- and Pain Medicine, Friederikenstift Hannover, Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Gottschalk
authors.affiliation: Department of Anesthesia, Intensive and Palliative Care Medicine, Academic Hospital Solingen, Solingen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Standl
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Stork
authors.affiliation: Department of Anesthesiology and Intensive Care, Friedrich-Schiller University Hospital, Jena, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Meißner
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, Berufsgenossenschaftliche Unfallklinik, Frankfurt am Main, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Teßmann
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, University and Rehabilitation Clinics, Ulm, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Geiger
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Koch
authors.affiliation: Department of Anesthesiology and Operative Intensive Care Medicine, Charité Campus Virchow Klinikum and Campus Mitte, Charité University Medicine Berlin, Berlin, Germany.
authors.forename: C D
authors.initials: CD
authors.lastname: Spies
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University of Saarland, Saarland University Medical Center, Homburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Volk
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University of Saarland, Saarland University Medical Center, Homburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kubulus
mesh_terms: D017677:Age Distribution; D000704:Analysis of Variance; D000765:Anesthesia, Conduction; D055499:Catheter-Related Infections / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013997:Time Factors