Preventing Surgical Site Infections after Bariatric Surgery: Value of Perioperative Antibiotic Regimens

Teena Chopra; Jing J Zhao; George Alangaden; Michael H Wood; Keith S Kaye

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2010;10(3):317-328. 

In This Article

Background

Obesity is a major public health problem with the numbers of obese individuals globally increasing. In the USA, 5.2% of adults are morbidly obese (BMI >40).[1] Despite improvements in the medical care of associated comorbid conditions, such as Type 2 diabetes and cardiovascular disease, there is a direct association between obesity and increased mortality.[2] According to a recent study, by the year 2030, approximately 90% (86.3%) of all American adults will be overweight or obese.[3] Total healthcare costs attributable to obesity are estimated to double every decade, will reach US$860.7–US$956.9 billion by 2030 and will account for 16–18% of total US healthcare costs.[3] Nonsurgical interventions are initially recommended for the management of obesity. However, bariatric surgery is being increasingly utilized for patients with a BMI of more than 35 or 40 with other comorbid conditions who are unresponsive to medical interventions.

Recent reports indicate a tenfold increase in the number of bariatric surgical procedures performed in the USA from 16,200 in 1994 to 171,000 in 2005.[4] Furthermore, an increasing number of older adults (>60 years) are being offered bariatric surgery as a weight loss measure owing to widespread obesity and the fact that the population is living longer.[5] Many studies have demonstrated a greater reduction in weight loss and a 25–40% reduction in overall mortality in obese patients following bariatric surgery compared with patients treated nonsurgically.[6–8]

Surgery performed on an obese patient is associated with an increased risk for postoperative complications including surgical site infections (SSIs). The reported incidence of SSIs following bariatric surgery is approximately 15%,[9] which is similar to the rate of SSI for obese patients undergoing nonbariatric abdominal surgeries.[10]

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