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Surgical Site Infection Risk Factor Analysis in Postbariatric Patients Undergoing Body Contouring Surgery

A Nested Case-Control Study

Wiser, Itay, MD, PhD*†; Plonski, Lori, MD*; Shimon, Nitai, MD*; Friedman, Tali, MD*; Heller, Lior, MD*

doi: 10.1097/SAP.0000000000001819
Aesthetic Surgery

Background Surgical site infections (SSIs) following body-contouring plastic surgery pose a significant burden on patients and caregivers, possibly leading to undesired surgical outcomes. Surgical site infection incidence following body-contouring plastic surgery ranges from 2% to 7%, but is estimated much higher among postbariatric massive weight loss (MWL) patients.

Objective The aim of this study was to evaluate SSI rate, risk and protective factors among postbariatric MWL patients following body-contouring plastic surgery.

Methods This was a nested case-control study of MWL patients who underwent body-contouring plastic surgery at the Department of Plastic Surgery at Assaf Harofeh Medical Center, between 2007 and 2014. Data were obtained from medical records. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Logistic regression was conducted to assess independent risk factors for SSIs.

Results From a cohort of 172 patients, 86 were included in the study. Surgical site infection rate was 20% (n = 17). Significant SSI risk factors included lifetime maximal weight and lifetime maximal body mass index (P = 0.039 and P = 0.002, respectively), body mass index loss prior to surgery (P = 0.032), estimated blood loss during surgery (P = 0.002), and gynecomastia repair procedure (P = 0.038). Independent SSI-associated factors included thigh lift procedure (odds ratio, 4.66; 95% confidence interval, 1.13–19.28) and preoperative antimicrobial prophylaxis (odds ratio, 0.04; 95% confidence interval, 0.03–0.61).

Conclusions Although not required by current guidelines for body-contouring plastic surgery, preoperative antimicrobial prophylaxis in our study demonstrated a significant protective effect against SSIs. Further research may reveal its true contribution to SSI prevention in body-contouring plastic surgery.

From the *Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and

Department of Epidemiology and Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Received April 26, 2018, and accepted for publication, after revision November 26, 2018.

Conflicts of interest and sources of funding: none declared.

The work was performed in the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.

Reprints: Itay Wiser, MD, PhD, Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel. E-mail:

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