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Seasonal Impact on Surgical-Site Infections in Body Contouring Surgery: A Retrospective Cohort Study of 602 Patients over a Period of 6 Years

Duscher, Dominik, M.D.; Kiesl, David, M.D.; Aitzetmüller, Matthias Michael, M.D.; Wenny, Raphael, M.D.; Schableger, Karl, M.Sc.; Staud, Clement Johannes, M.D.; Pollhammer, Michael Stefan, M.D.; Shamiyeh, Andreas, M.D.; Huemer, Georg M., M.D., M.Sc., M.B.A.

Plastic and Reconstructive Surgery: September 2018 - Volume 142 - Issue 3 - p 653–660
doi: 10.1097/PRS.0000000000004677
Cosmetic: Original Articles
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Background: Postoperative surgical-site infections are severe complications following body contouring surgery. Here, the authors evaluate whether surgical-site infection rates are influenced by higher temperatures during the summer season.

Methods: We enrolled 602 patients who underwent body contouring surgery between 2009 and 2015 in a retrospective cohort study. Data collected included demographics, surgical data, and postoperative outcome. Body contouring surgery procedures included lower and upper body lift, abdominoplasty, breast reduction, mastopexy, brachioplasty, and thigh lift. Infection rates were calculated on a seasonal basis and compared using Fisher’s exact test and logistic regression analysis.

Results: There were 136 patients (125 women and 11 men) in the warm season [June to August; with an average temperature of 67.622°F (19.79°C)] and 466 patients (438 women and 28 men) in the cold seasons group [September to May, with an average temperature of 45.45 °F (7.47°C)]. The composition of the study cohorts was comparable. The average age was 40 years and the average body mass index was 27 kg/m2. From a total of 602 patients, the authors observed 33 surgical-site infections, representing a rate of 5.48 percent. A statistically significant increase of postoperative surgical-site infections could be detected during summer (10.29 percent versus 4.08 percent; p = 0.0071), representing an increase of 150 percent. In addition, a logistic regression analysis determined “season” as the strongest predictor for surgical-site infections, with a risk increase of 2.693 times in the warm season.

Conclusions: Body contouring operations are elective procedures, making careful risk consideration an absolute prerequisite. The authors demonstrate a significantly increased infection risk during summer and establish a causal link between the warm season and surgical-site infection accumulation. Consequently, preoperative patient information and operative planning should be adjusted accordingly.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Linz, Wels, and St. Pölten, Austria; and Munich, Germany

From the Section of Plastic and Reconstructive Surgery and the Department of Surgery, Kepler University Hospital Linz; Upper Austrian State Medical Insurance; private practice; the Department of Plastic and Reconstructive Surgery, University Clinic St. Pölten; and the Department of Plastic and Hand Surgery, Technical University Munich.

Received for publication August 1, 2017; accepted January 25, 2018.

The first three authors contributed equally to this work.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch.

Georg M. Huemer, M.D., M.Sc., M.B.A., Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria, ghuemer@drhuemer.com

©2018American Society of Plastic Surgeons