Risk factors for the development of surgical site infection in bariatric surgery: an integrative review of literature

Silva, Ana Flávia da; Mendes, Karina Dal Sasso; Ribeiro, Vanessa dos Santos; Galvão, Cristina Maria

doi:10.1590/1518-8345.6309.3798

Ana Flávia da Silva

Study concept and design

Obtaining data

Data analysis and interpretation

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Unimed, Hospital da Unimed, Ribeirão Preto, SP, Brazil

http://orcid.org/0000-0002-9822-0364

Karina Dal Sasso Mendes

Study concept and design

Obtaining data

Data analysis and interpretation

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil

http://orcid.org/0000-0003-3349-2075

Vanessa dos Santos Ribeiro

Obtaining data

Data analysis and interpretation

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil

http://orcid.org/0000-0002-0686-4307

Cristina Maria Galvão

Study concept and design

Obtaining data

Data analysis and interpretation

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil

Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

http://orcid.org/0000-0002-4141-7107

Corresponding author
Cristina Maria Galvão E-mail: crisgalv@eerp.usp.br

Associate Editor

Maria Lúcia Zanetti

Conflict of interest

The authors have declared that there is no conflict of interest.

Primary study/year of publication	Type of study/sample	Objective (s)	Risk factors
Ruiz-Tovar, et al. (2013)¹⁴14. Ruiz-Tovar J, Oller I, Llavero C, Arroyo A, Muñoz JL, Calero A, et al. Pre-operative and early post-operative factors associated with surgical site infection after laparoscopic sleeve gastrectomy. Surg Infect. 2013;14(4):369-73. Doi: 10.1089/sur.2012.114 https://doi.org/10.1089/sur.2012.114...	Prospective study (authors) Sample: n=40	To investigate the association of comorbidities and pre and postoperative variables with surgical site infection after sleeve gastrectomy.	Preoperative: BMI*>45 kg/m²; restrictive disorders identified by pulmonary function tests; serum total protein concentration <5.3 g/dL; plasma cortisol >30 mcg/dL; MCV^† < 82 fL. Postoperative: blood glucose > 128 mg/dL; hemoglobin <11 g/dL (variables associated with SSI^‡ only in univariate analysis)
Lyons, et al. (2014)¹⁵15. Lyons T, Neff KJ, Benn J, Chuah LL, Roux CW, Gilchrist M. Body mass index and diabetes status do not affect postoperative infection rates after bariatric surgery. Surg Obes Relat Dis. 2014;10(2):291-7. Doi: 10.1016/j.soard.2013.10.006 https://doi.org/10.1016/j.soard.2013.10....	Retrospective cohort study (authors) Sample: n=815	To quantify the rate of postoperative infection after bariatric surgery. To determine whether infection-related events contribute to lengthening hospital stays and to assess the effect of risk factors, such as diabetes, on infection rates.	The authors did not analyze risk factors for SSI, but for general infection that occurred in the postoperative period.
Vetter, et al. (2017)¹⁶16. Vetter D, Raptis DA, Giama M, Hosa H, Muller MK, Nocito A, et al. Planned secondary wound closure at the circular stapler insertion site after laparoscopic gastric bypass reduces postoperative morbidity, costs, and hospital stay. Langenbecks Arch Surg. 2017;402(8):1255-62. Doi: 10.1007/s00423-017-1632-3 https://doi.org/10.1007/s00423-017-1632-...	Retrospective study (authors) Sample: n=1,400	To assess whether a secondary, planned wound closure in the upper left abdomen reduces the rate of wound infection and whether such a technique has a positive impact on hospital stay, costs, and postoperative morbidity.	Women; primary wound closure; dyslipidemia and presence of preoperative gastritis (analytical statistical treatment)
Meister, et al. (2018)¹⁷17. Meister KM, Hufford T, Tu C, Khorgami Z, Schauer PR, Brethauer AS, et al. Clinical significance of perioperative hyperglycemia in bariatric surgery: evidence for better perioperative glucose management. Surg Obes Relat Dis. 2018;14(11):1725-31. Doi: 10.1016/j.soard.2018.07.028 https://doi.org/10.1016/j.soard.2018.07....	Retrospective study (authors) Sample: n=1,981	To assess the significance of perioperative hyperglycemia in different complications of infection (six types of infection were investigated, including surgical site infection) and clinical outcomes.	In univariate analysis, perioperative hyperglycemia was associated with the development of SSI in patients with diabetes.
Dang, et al. (2020)¹⁸18. Dang JT, Tran C, Switzer N, Delisle M, Laffin M, Madsen K, et al. Predicting surgical site infections following laparoscopic bariatric surgery: development of the BariWound tool using the MBSAQIP database. Surg Endosc. 2020;34(4):1802-11. Doi: 10.1007/s00464-019-06932-6 https://doi.org/10.1007/s00464-019-06932...	Retrospective study Sample: n=274,187	To develop a predictive tool for surgical site infection after 30 days of bariatric surgery.	Roux-en-Y gastric bypass surgery; chronic use of steroids or immunosuppressants; women; gastroesophageal reflux disease; hypertension; diabetes mellitus; White breed; long operative time; sleep apnea and high BMI (analytical statistical treatment)
Falvo, et al. (2020)¹⁹19. Falvo A, Vacharathit V, Kuhn JE, Fluck M, Cunningham RM, Petrick AT, et al. Comparison of short-term outcomes following Roux-en-Y gastric bypass in male and female patients using the MBSAQIP database. Surg Obes Relat Dis. 2020;16(9):1236-41. Doi: 10.1016/j.soard.2020.04.045 https://doi.org/10.1016/j.soard.2020.04....	Retrospective study Sample: n=47,906	To compare short-term results (30 days after surgery), by biological sex, of patients undergoing Roux-en-Y gastric bypass.	In the study there was no analysis of this nature.

Primary study/year of publication	Type of study/sample	Objective (s)	Risk factors
Freeman, et al. (2011)²⁰20. Freeman JT, Anderson DJ, Hartwig MG, Sexton DJ. Surgical site infections following bariatric surgery in community hospitals: a weighty concern? Obes Surg. 2011;21(7):836-40. Doi: 10.1007/s11695-010-0105-3 https://doi.org/10.1007/s11695-010-0105-...	Prospective cohort study (authors) Sample: n=2,012	To assess the surgical site infection rate of group patients from community hospitals and compare with previously published rates of patients in tertiary hospitals.	Antibiotic prophylaxis (analytical statistical treatment).
Chopra, et al. (2012)²¹21. Chopra T, Marchaim D, Lynch Y, Kosmidis C, Zhao JJ, Dhar S, et al. Epidemiology and outcomes associated with surgical site infection following bariatric surgery. Am J Infec Control. 2012;40(9):815-9. Doi: 10.1016/j.ajic.2011.10.015 https://doi.org/10.1016/j.ajic.2011.10.0...	Case-control study (authors) Sample: n=751	To assess the importance of potential risk factors for surgical site infection after bariatric surgery.	Sleep apnea; bipolar disorder; surgery duration (> 180 minutes); use of prophylactic antimicrobials other than cefazolin (analytical statistical treatment).
Gerber, et al. (2018)²²22. Gerber P, Anderin C, Szabo E, Näslund I, Thorell A. Impact of age on risk of complications after gastric bypass: a cohort study from the Scandinavian obesity surgery registry (SOReg). Surg Obes Relat Dis. 2018;14(4):437-42. Doi: 10.1016/j.soard.2017.12.024 https://doi.org/10.1016/j.soard.2017.12....	Cohort study (authors) Sample: n=47,660	Define the risk of complications and mortality in relation to age after gastric bypass.	Age (analytical statistical treatment).
Ferraz, et al. (2019)²³23. Ferraz AAB, Vasconcelos CFM, Santa-Cruz F, Aquino MAR, Buenos-Aires VG, Siqueira LT. Surgical site infection in bariatric surgery: results of a care bundle. Rev Col Bras Cir. 2019;46(4); e2252. Doi: 10.1590/0100-6991e-20192252 https://doi.org/10.1590/0100-6991e-20192...	Prospective cohort study (authors) Sample: n=1.596	To present a descriptive analysis of the results of a care package applied to obese patients undergoing bariatric surgery for infection control.	Body mass index; diabetes mellitus (correlation between variables).
Gray, et al. (2020)⁴4. Gray EC, Dawoud F, Janelle M, Hodge M. Drain placement during bariatric surgery, helpful or harmful? Am Surg. 2020;86(8):971-5. Doi: 10.1177/0003134820942168 https://doi.org/10.1177/0003134820942168...	Retrospective study (authors) Sample: n=148,260	Explore the routine use of abdominal drain placement in sleeve gastrectomy and Roux-en-Y gastric bypass surgeries to assess associated complications and potential risk factors.	Drain (analytical statistical treatment).

Retrospective/Prospective study	Q1^*	Q2^†	Q3^‡	Q4^§	Q5^\|\|	Q6^¶\|	Q7^**	Q8^††	Q9^‡‡	Total (Yes)
Ruiz-Tovar, et al. (2013)¹⁴14. Ruiz-Tovar J, Oller I, Llavero C, Arroyo A, Muñoz JL, Calero A, et al. Pre-operative and early post-operative factors associated with surgical site infection after laparoscopic sleeve gastrectomy. Surg Infect. 2013;14(4):369-73. Doi: 10.1089/sur.2012.114 https://doi.org/10.1089/sur.2012.114...	Y^§§	Y	N^\|\|\|\|	Y	Y	Y	Y	Y	NA^¶¶	7
Vetter, et al. (2017)¹⁶16. Vetter D, Raptis DA, Giama M, Hosa H, Muller MK, Nocito A, et al. Planned secondary wound closure at the circular stapler insertion site after laparoscopic gastric bypass reduces postoperative morbidity, costs, and hospital stay. Langenbecks Arch Surg. 2017;402(8):1255-62. Doi: 10.1007/s00423-017-1632-3 https://doi.org/10.1007/s00423-017-1632-...	Y	Y	Y	Y	Y	Y	Y	Y	NA	8
Meister, et al. (2018)¹⁷17. Meister KM, Hufford T, Tu C, Khorgami Z, Schauer PR, Brethauer AS, et al. Clinical significance of perioperative hyperglycemia in bariatric surgery: evidence for better perioperative glucose management. Surg Obes Relat Dis. 2018;14(11):1725-31. Doi: 10.1016/j.soard.2018.07.028 https://doi.org/10.1016/j.soard.2018.07....	Y	Y	Y	Y	Y	Y	Y	Y	NA	8
Dang, et al. (2020)¹⁸18. Dang JT, Tran C, Switzer N, Delisle M, Laffin M, Madsen K, et al. Predicting surgical site infections following laparoscopic bariatric surgery: development of the BariWound tool using the MBSAQIP database. Surg Endosc. 2020;34(4):1802-11. Doi: 10.1007/s00464-019-06932-6 https://doi.org/10.1007/s00464-019-06932...	Y	Y	Y	Y	Y	Y	Y	Y	NA	8
Falvo, et al. (2020)¹⁹19. Falvo A, Vacharathit V, Kuhn JE, Fluck M, Cunningham RM, Petrick AT, et al. Comparison of short-term outcomes following Roux-en-Y gastric bypass in male and female patients using the MBSAQIP database. Surg Obes Relat Dis. 2020;16(9):1236-41. Doi: 10.1016/j.soard.2020.04.045 https://doi.org/10.1016/j.soard.2020.04....	Y	Y	Y	Y	Y	U^***	U	N	NA	5
Gray, et al. (2020)⁴4. Gray EC, Dawoud F, Janelle M, Hodge M. Drain placement during bariatric surgery, helpful or harmful? Am Surg. 2020;86(8):971-5. Doi: 10.1177/0003134820942168 https://doi.org/10.1177/0003134820942168...	Y	Y	Y	Y	Y	U	U	Y	NA	6

Coorth study	Q1^*	Q2^†	Q3^‡	Q4^§	Q5^\|\|	Q6^¶\|	Q7^**	Q8^††	Q9^‡‡	Q10^§§	Q11^\|\|\|\|	Total (Yes)
Freeman, et al. (2011)²⁰20. Freeman JT, Anderson DJ, Hartwig MG, Sexton DJ. Surgical site infections following bariatric surgery in community hospitals: a weighty concern? Obes Surg. 2011;21(7):836-40. Doi: 10.1007/s11695-010-0105-3 https://doi.org/10.1007/s11695-010-0105-...	Y^¶\|¶\|	Y	Y	N^***	N	Y	Y	U^†††	U	U	Y	6
Lyons, et al. (2014)¹⁵15. Lyons T, Neff KJ, Benn J, Chuah LL, Roux CW, Gilchrist M. Body mass index and diabetes status do not affect postoperative infection rates after bariatric surgery. Surg Obes Relat Dis. 2014;10(2):291-7. Doi: 10.1016/j.soard.2013.10.006 https://doi.org/10.1016/j.soard.2013.10....	Y	Y	Y	N	N	Y	Y	Y	Y	NA^‡‡‡	N	7
Gerber, et al. (2018)²²22. Gerber P, Anderin C, Szabo E, Näslund I, Thorell A. Impact of age on risk of complications after gastric bypass: a cohort study from the Scandinavian obesity surgery registry (SOReg). Surg Obes Relat Dis. 2018;14(4):437-42. Doi: 10.1016/j.soard.2017.12.024 https://doi.org/10.1016/j.soard.2017.12....	Y	Y	Y	N	N	Y	U	Y	Y	NA	Y	7
Ferraz, et al. (2019)²³23. Ferraz AAB, Vasconcelos CFM, Santa-Cruz F, Aquino MAR, Buenos-Aires VG, Siqueira LT. Surgical site infection in bariatric surgery: results of a care bundle. Rev Col Bras Cir. 2019;46(4); e2252. Doi: 10.1590/0100-6991e-20192252 https://doi.org/10.1590/0100-6991e-20192...	Y	Y	Y	N	N	Y	U	Y	Y	NA	N	6

[1] Corresponding author
Cristina Maria Galvão E-mail: crisgalv@eerp.usp.br

Brasil

Brasil

Risk factors for the development of surgical site infection in bariatric surgery: an integrative review of literature

Abstract

Objective:

Method:

Results:

Conclusion: