Fat Thickness as a Risk Factor for Infection in Lumbar Spine Surgery

Abstract

Body mass index does not account for body mass distribution. This study tested the hypothesis that subcutaneous fat thickness is a better indicator than body mass index of the risk of surgical site infection in lumbar spine procedures performed through a midline posterior approach. Charts were reviewed for previously identified risk factors for surgical site infection (age, diabetes, smoking, obesity, albumin level, multilevel procedures, previous surgery, and operative time) in 149 adult patients who underwent lumbar spine procedures through a midline posterior approach. Subcutaneous fat thickness was measured with a novel automated technique. Regression analysis was used to determine associations between risk factors and fat thickness with surgical site infection. In the study group, 15 surgical site infections occurred (10.1%). Bivariate analysis showed a significant association between surgical site infection and body mass index (P=.01), obesity (P=.02), and fat thickness (P=.002). With multivariate analysis, body mass index and obesity did not show significance, but fat thickness remained significant (P=.026). For every 1-mm thickness of subcutaneous fat there was a 6% (odds ratio, 1.06; 95% confidence interval, 1.02-1.10) increase in the odds of surgical site infection, and patients with fat thickness of greater than 50 mm had a 4-fold increase in the odds of surgical site infection compared with those with fat thickness of less than 50 mm. Body mass index and fat thickness were moderately correlated (r=0.44). These results confirm the hypothesis that local subcutaneous fat thickness is a better indicator than body mass index of the risk of surgical site infection in lumbar spine procedures. [Orthopedics. 2016; 39(6):e1124-e1128.].

Correlation between lumbar multifidus fat infiltration and lumbar postoperative infection: a retrospective case–control study

“…Previous studies have reported an SSI rate of 0.7-12% in lumbar spine surgeries [24], which is comparable with the 2.04% reported in our study. SSI development is multifactorial, and we found that male sex, age > 60 years, subcutaneous fat thickness, and drainage duration are independent risk factors for SSI development following PLIF, which is in agreement with previous studies [8,9,[23][24][25]. LMM, as one of the main components of the trunk extensor muscle, plays a significant role in trunk rotation, spinal stability, lumbar lordosis, and other aspects [26].…”

“…Subcutaneous fat thickness was calculated as the distance from the spinous processes to the back skin in a standardized manner with T2-weighted images reformatted into axial and sagittal orientations (Fig. 2) [23]. All measurements were performed at the operative levels.…”

Bilateral Pulmonary Artery Embolism Following Posterior Spinal Surgery

“…Venous stasis in lower extremities is another cause of embolism, as well as a major risk factor for embolism 2 Trauma Mon. In Press(In Press):e62147.…”

“…Lumbar spine laminectomy and spinal fixation are common procedures (1), associated with some recognized complications, such as postoperative infections (2), nerve root damage, dural tear (3), and pulmonary embolism (PE) (4), which can be fatal (5). The prevalence of thromboembolic events during these types of procedures ranges from 0% to 13% (6).…”

Robotic Versus Open Renal Transplantation in Obese Patients: Protocol for a Cost-Benefit Markov Model Analysis (Preprint)

“…Obese patients have a higher prevalence of diabetes that is a predisposing factor for delayed wound healing and to bacterial infections [23][24][25][26]. In addition, due to the extra-adipose tissue in the subcuticular space, obese patiens are prone to develop seromas that often become infected because of the suboptimal vascularization of the adipose tissue [27][28][29][30]. In addition, obese patients require longer incisions and their surgeries are, most of the time longer with subsequent increased risk of tissue dissication and intraoperative contamination [1] that are predisposing factors for incisional hernias [31].…”