BACKGROUND Although bariatric surgery is a safe procedure for severe obesity, incisional surgical site infections (SSI) remain a significant cause of morbidity. Bariatric surgery patients are at high risk due to obesity and diabetes. The objective of this study was to develop a predictive tool for incisional SSI within 30 days of bariatric surgery. METHODS Data were retrieved from the 2015 and 2016 MBSAQIP databases. This study included patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG). The primary outcome of interest was incisional SSI occurring within 30 days. Surgeries performed in 2015 were used in a derivation cohort and the predictive tool was validated against the 2016 cohort. A forward selection algorithm was used to build a logistic regression model predicting probability of SSI. RESULTS A total of 274,187 patients were included with 71.7% being LSG and 28.3% LRYGB. 0.7% of patients had a SSI in which 71.0% had an incisional SSI, and 29.9% had an organ/space SSI. Of patients who had an incisional SSI, 88.7% were superficial, 10.9% were deep, and 0.4% were both. A prediction model to assess for risk of incisional SSI, BariWound, was derived and validated. BariWound consists of procedure type, chronic steroid or immunosuppressant use, gastroesophageal reflux disease, obstructive sleep apnea, sex, type 2 diabetes, hypertension, operative time, and body mass index. It stratifies individuals into very high (> 10%), high (5-10%), medium (1-5%), and low risk (< 1%) groups. This model accurately predicted events in the validation cohort with an area under the receiver operating characteristic curve of 0.73. CONCLUSIONS BariWound accurately predicted the risk of 30-day incisional SSI in individuals undergoing bariatric surgery. Stratifying low- and high-risk groups allows for customized SSI prophylactic measures for patients in various risk categories and potentially enables future research targeted at high-risk patients.

中文翻译：

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预测腹腔镜减肥手术后的手术部位感染：使用 MBSAQIP 数据库开发 BariWound 工具。

背景尽管减肥手术对于严重肥胖是一种安全的手术，但切口手术部位感染 (SSI) 仍然是发病的重要原因。由于肥胖和糖尿病，减肥手术患者处于高风险之中。本研究的目的是开发一种在减肥手术后 30 天内对切口 SSI 进行预测的工具。方法 从 2015 年和 2016 年 MBSAQIP 数据库中检索数据。这项研究包括接受原发性腹腔镜 Roux-en-Y 胃旁路术 (LRYGB) 或腹腔镜袖状胃切除术 (LSG) 的患者。感兴趣的主要结果是 30 天内发生的切口 SSI。2015 年进行的手术用于衍生队列，预测工具针对 2016 年队列进行了验证。使用前向选择算法建立逻辑回归模型预测 SSI 的概率。结果 共纳入 274,187 名患者，其中 LSG 占 71.7%，LRYGB 占 28.3%。0.7% 的患者有 SSI，其中 71.0% 有切口 SSI，29.9% 有器官/空间 SSI。在有切口 SSI 的患者中，88.7% 为浅表，10.9% 为深部，0.4% 为两者。推导出并验证了用于评估切口 SSI 风险的预测模型 BariWound。BariWound 包括手术类型、慢性类固醇或免疫抑制剂的使用、胃食管反流病、阻塞性睡眠呼吸暂停、性别、2 型糖尿病、高血压、手术时间和体重指数。它将个体分为非常高 (> 10%)、高 (5-10%)、中 (1-5%) 和低风险 (< 1%) 组。该模型准确地预测了验证队列中的事件，接收者操作特征曲线下的面积为 0.73。结论 BariWound 准确预测了接受减肥手术的个体 30 天切口 SSI 的风险。对低风险和高风险人群进行分层可以为各种风险类别的患者定制 SSI 预防措施，并可能使未来针对高风险患者的研究成为可能。