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

Expert Commentary

Bariatric surgery has provided a very effective treatment modality that is, in some cases, life-sustaining for obese patients. From an infection prevention perspective, there are several interventions that can be utilized to decrease the risk for SSIs. Adequately treating active infections in the preoperative period, thoroughly and carefully preparing the patient's skin and operative site, administering antimicrobial prophylaxis in an appropriate manner, minimizing the duration of surgery and utilizing more laparoscopic approaches rather than open approaches will all help to minimize SSI risk. Gentle handling and manipulation of tissues during surgery can also decrease SSI risk.

However, several issues remain unresolved. The optimal dosing of prophylactic antimicrobials has not been well studied, particularly in the morbidly obese population. The role of periopertive glucose control, which has been extremely effective in reducing SSIs following cardiothoracic surgery[88] and perioperative warming of the patient, which has been extremely effective in reducing SSI risk following colorectal surgery, have not been explored.[89] In addition, the role of oxygen supplementation, which has been effectively used in colorectal surgical populations to reduce SSI risk, has not been explored in the bariatric population. Trials utilizing one or more of these processes would be well received and might provide much needed evidence-based data regarding SSI prevention.

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