Abstract Category: Research

Purpose: In 2014, Diabetes Mellitus (DM), was the 7th leading cause of death in America. Over one-third of all surgical procedures occur in adults aged 65 years and older and this proportion is only expected to further expand. With the swelling prevalence of surgical procedures, reduction of complications such as surgical site infections (SSIs) are becoming more important. A new observational study determined that SSIs were the most common nosocomial infection, accounting for 31 % of all hospital acquired infections among hospitalized patients. The goal of this study was to determine if Diabetes Mellitus modifies the association between increasing Body Mass Index (BMI) and Surgical Site Infections in Medicare age patients who have undergone laparoscopic abdominal surgery.

Methods: In this retrospective cohort study (n=54,064), data was extrapolated from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Covariates used in the analysis were age, sex, smoking, COPD history, Ascites, Functional Status, CHF history, Renal Failure, Hypertension, Disseminated Cancer, chronic steroid use, sepsis, emergency case, and WBC count. Records of patients with missing key variables or patients <45y/o were excluded. Unadjusted and adjusted logistic regression were used to assess the association between obesity, DM, and SSI.

Findings: There was no evidence of an effect modification of the association between BMI and SSI by DM (p-value=0.572). There was no statistically significant increased risk for SSI in obese patients with DM (odds ratio (OR) = 1.34; 95% confidence interval (CI) 0.95-1.89) compared with normal weight DM patients. However, in patients without diabetes, obesity increased the risk of SSI 1.26-times (95% CI 1.08-1.49). Our multivariate logistic regression model demonstrated that obesity (OR=1.29; CI 1.12-1.49) and DM (OR=1.24; CI 1.08-1.41) were independent risk factors for SSI in laparoscopic abdominal surgery. Medicare age was found to be an insignificant risk factor (OR=1.17; CI 0.99-1.28) for SSI unless other comorbidities were present such as history of smoking, CHF, HTN, COPD, or Diabetes Mellitus.

Discussion: Our study found that DM did not modify the association between obesity and SSI. Medicare age patients showed no increased risk for SSI in laparoscopic surgeries of the abdomen. In our multivariate model, Obesity (BMI > 30 kg/m2) and DM were significant independent risk factors for SSI. When checking for effect modification by DM, there was no significant increased risk for SSI in obese patients with DM compared to obese patients without DM.

Implications for Practice: In this study we demonstrated that obesity and DM are independent risk factors for SSI in laparoscopic abdominal surgery. We recommend surgeons not to use BMI as a predictor for SSI, but only when patients are clinically obese BMI>30 kg/m2 or other comorbidities such as DM, CHF, COPD, disseminated cancer, and chronic steroid use are present. As DM is an independent risk factor of SSI, these patients may need special attention after laparoscopic surgery.

Publication Date


Presented At:

2018 West Kendall Baptist Hospital Scholarly Showcase

Content Type



Authors (FIU Herbert Wertheim College of Medicine Affiliates):

Andrew Manfra, M.S. Medical Student

Israel Mostafa, M.S. Medical Student

Arnav Gupta, M.S. Medical Student


Andrew Manfra, M.S.

Arnav Gupta, M.S.

Israel Mostafa, M.S.

Grettel Castro

Juan Carlos Gonzales

Jaime Rodriguez

Noël C Barengo

Open Access

Available to all.