Incidence and Risk Factors for Major Surgical Site Infections in Aesthetic Surgery: Analysis of 129,007 Patients.
BACKGROUND
Surgical site infections (SSIs) represent one of the most common postoperative complications in patients undergoing aesthetic surgery.


OBJECTIVE
This study reports the incidence and risk factors of major SSIs following aesthetic surgery.


METHODS
A prospective cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of a major SSI requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis evaluated potential risk factors for SSIs including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures.


RESULTS
A total of 129,007 patients were identified, of which 599 (0.46%) had a major SSI. Mean age (43.8 ± 12.4 years vs 40.9 ± 13.9 years, P < .01) and BMI (27.3 ± 5.5 kg/m2vs 24.3 ± 4.6 kg/m2, P < .01) were higher in patients with SSIs. Patients with a SSI were more likely to be smokers (10.5% vs 8.2%, P = .04) and diabetic (4.5% vs 1.8%, P < .01). Females suffered more SSI than males (0.5% vs 0.3%, P = .02). Trunk/extremity procedures had a higher incidence of SSI compared to breast or face procedures (0.9% vs 0.2%, P < .01). On multivariate analysis, independent predictors of SSI included age (Relative Risk [RR] 1.01), female gender (RR 1.86), BMI (RR 1.07), smoking (RR 1.61), diabetes (RR 1.58), hospital or ambulatory surgery center procedures (RR 1.39), trunk/extremity procedures (RR 2.42), and combined procedures (RR 1.88).


CONCLUSIONS
SSIs following cosmetic surgical procedures are associated with numerous independent predictors, which should be taken into consideration when counseling patients undergoing aesthetic surgery.


METHODS
2 Risk.
Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal ckaoutzanis@gmail.com.
Christodoulos
C
Kaoutzanis
Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
Varun
V
Gupta
Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
Julian
J
Winocour
Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
Bruce
B
Shack
Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
James C
JC
Grotting
Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal.
Kent
K
Higdon
D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D003357:Cosmetic Techniques / Q000009:adverse effects*; D016208:Databases, Factual; D004636:Emergency Service, Hospital; D004954:Esthetics; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D018579:Patient Selection; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult