Surgical Site Infections Following Laparoscopic Bariatric Surgery

Abstract

BACKGROUND/OBJECTIVES: The U.S. is experiencing a national epidemic of obesity. Currently 5 % of the population is considered morbidly obese (body mass index [BMI] >40 kg/m 2 ) and bariatric surgery has become popular as an effective therapy for morbid obesity. The term bariatric surgery encompasses a variety of surgical procedures and there is limited published infection data. Our institution established a Bariatric and Metabolic Institute in 2004 and surveillance for surgical site infections (SSI) and bloodstream infections (BSI) was initiated July 1, 2005. METHODS: Laparoscopic bariatric procedures were categorized as Roux-en-Y gastric bypass (RYGB); gastric banding; and sleeve gastrectomy. CDC definitions were used for superficial, deep and organ space SSI, as well as for BSI. Case ascertainment was performed by rounding on the bariatric unit, review of laboratory culture reports and communication with the Bariatric Center. A laparoscopic procedure that during the course of surgery is changed to an open laparotomy is considered a conversion. RESULTS: 161 procedures were performed by 2 surgeons from July 1, through December 31, 2005. Of these 73% (117/161) were RYGB; 22% (35/161) were gastric banding; and 5% (9/161) sleeve gastrectomies. In the RYGB group there were a total of 5 SSIs with an overall infection incidence rate of 4.3%. Four infections were organ space and one superficial. Sixty percent of SSI cases were polymicrobial (3/5). Gram positive organisms constituted 63% of pathogens. Pathogens included Streptococcus milleri (2), Enterococcus (1), Streptococcus viridans (1), Escherichia coli (1), Bacteroides fragilis (1) and Lactobacillus (1). In one case no pathogen was identified. Of the 5 patients with SSI, 3 were male. The mean age was 46.6 years (range 35 - 53 years), with a mean BMI of 49.8 (range 38-66). The mean duration of surgery was 353 minutes (range of 260-464 minutes). Pre-operative Cefazolin was given within 60 minutes of incision time in all but one infected case. Routine antibiotic orders are for cefazolin 1 gram IV every eight hours for 24 hours. There was an anastomotic leak noted in 80% of SSIs. There were no infections in the gastric banding and sleeve gastrectomy cases. The conversion rate for laparoscopic RYGB to open laparotomy was 0.9% (1/117). There were no BSIs. CONCLUSIONS: A six month summary of our bariatric surgical center data revealed a significant number of bariatric cases with RYGB the most commonly performed procedure. The SSI infection rate of 4.3% is within the range of 1-10% reported in the literature. The rate for Laparoscopic RYGB conversion to a laparotomy is 0.9%.