INCREASED INCIDENCE OF NOSOCOMIAL INFECTIONS IN OBESE SURGICAL PATIENTS

Obesity has long been considered a potential risk factor for poor outc ome following surgical procedures. However, controversy exists regardi ng the clinical impact of this problem because of a paucity of data re garding the incidence and risk of nosocomial infections in obese surgi cal patients. This retrospective study was undertaken to compare the n osocomial infection rate in obese and normal weight surgical patients. All patients undergoing general, urologic, vascular, thoracic, or gyn ecologic surgical procedures between October 1 and December 31, 1991, were reviewed. Nosocomial infection data were obtained from the Depart ment of Hospital Epidemiology. A total of 849 patients were evaluated, of which 536 (63%) were normal weight (BMI < 27 kg/m(2)), 175 (21%) w ere obese (BMI 27-31 kg/m(2)), and 138 (16%) were severely obese (BMI > 31 kg/m(2)). Age, mortality, and American Society of Anesthesia (ASA ) risk scores did not differ among the three groups. There were signif icant increases in the number and percent of nosocomial infections in the obese populations, with rates of 0.05 per cent in normal weight, c ompared to 2.8 per cent and 4.0 per cent in obese and severely obese g roups (P < 0.01). Infections consisted of seven wound infections, five C. difficile infections, one pneumonia, and three; bacteremias. No di fferences in distribution between groups were evident. Mortality was s imilar among the groups. These data support the hypothesis that obesit y is a significant risk factor for clinically relevant nosocomial infe ctions in surgical patients.