Abstract
BackgroundControversy exists as to whether obesity constitutes a risk-factor or a protective-factor for the development of nosocomial Infection (NI). According to the obesity-paradox, there is evidence that moderate obesity is a protective-factor. In Mexico few studies have focused on the nutritional status (NS) distribution in the hospital setting.ObjectivesThe aim of this study was to estimate the distribution of NS and the prevalence of nosocomial infection NI among adult elective surgery (ES) patients and to compare the clinical and anthropometric characteristics and length of stays (LOS) between obese and non-obese patients and between patients with and without NI.MethodsWe conducted a cross-sectional study with a sample (n = 82) adult ES patients (21–59 years old) who were recruited from a tertiary-care hospital. The prevalences of each NS category and NI were estimated, the assessments were compared between groups (Mann-Whitney, Chi-squared or the Fisher's-exact-test), and the association between preoperative risk-factors and NI was evaluated using odds ratios.ResultsThe distribution of subjects by NS category was: underweight (3.66%), normal-weight (28.05%), overweight (35.36%), and obese (32.93%). The prevalence of NI was 14.63%. The LOS was longer (p<0.001) for the patients who developed NI. The percentages of NI were: 33.3% in underweight, 18.52% in obese, 17.39% in normal-weight, and 6.90% in overweight patients.ConclusionThe prevalence of overweight and obesity in adult ES patients is high. The highest prevalence of NI occurred in the underweight and obese patients. The presence of NI considerably increased the LOS, resulting in higher medical care costs.
Highlights
The 2012 National Health and Nutrition Survey data for Mexico estimated a high prevalence (30.6%-49.0%) of overweight (25 kg/m2 Body mass index (BMI) < 30 kg/m2), a high prevalence (20.4%-47.8%) of obesity (BMI ! 30 kg/m2), and a low prevalence (1.0% among adults 20–59 years old) of underweight (IMC < 18.5 kg/m2) [1]
We conducted a cross-sectional study with a sample of 82 Mexican-Hispanic adults who were recruited prospectively between April 23rd, 2012 and January 10th, 2014 from consecutive elective surgery (ES) patients attending the gastrosurgery, neurosurgery and proctology departments at the tertiary care Mexican High-Specialty Regional Bajío Hospital (Hospital Regional de Alta Especialidad del Bajío, HRAEB). located in León City in Guanajuato state (Mexico)
The length of stays (LOS) was significantly longer in patients with nosocomial infection (NI), the patients who developed a NI had a LOS that was 14.51 days longer than the patients who did not develop NI (p < 0.001). This result is consistent with that reported by Angeles-Garay et al [38] and considering the concept of prolonged stay [39,40] our results suggest that the presence of NI generates a prolonged stay in adult ES patients, similar to the results by Erbaydar et al [41]
Summary
The 2012 National Health and Nutrition Survey data for Mexico estimated a high prevalence (30.6%-49.0%) of overweight (25 kg/m2 BMI < 30 kg/m2), a high prevalence (20.4%-47.8%) of obesity (BMI ! 30 kg/m2), and a low prevalence (1.0% among adults 20–59 years old) of underweight (IMC < 18.5 kg/m2) [1]. Because of the diversity of ES complications, they have been classified by the type of intervention necessary for treatment [5]. These complications include wound dehiscence, hematoma formation, slow healing, bleeding [6,7,8] and nosocomial infection (NI) [9]. The identified preoperative risk factors for developing NI include elderly age, long hospital stay prior to surgery, recent weight loss, presence of systemic diseases such as type 2 diabetes mellitus (T2DM) and hypertension (HTN), smoking, American Society of Anesthesiologists physical status (ASA-PS) score, immunosuppression, and altered nutritional status (NS) [10,11,12]. In Mexico few studies have focused on the nutritional status (NS) distribution in the hospital setting
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