Increased incidence of surgical site infection with a body mass index ≥ 35 kg/m² following abdominal wall reconstruction with open component separation

Background: To quantify the impact of body mass index (BMI) on surgical site infection (SSI) following abdominal wall reconstruction (AWR) using component separation techniques and attempt to identify obesity-related targets, such as BMI, that can be potentially used to guide preoperative patient optimization. Though AWR has established perioperative outcomes for hernia repair, the applicability in the obese population is not well established. Methods: The 2005–2013 ACS-NSQIP participant use file was reviewed to compare SSI, severe, and overall morbidity in non-emergent AWR patients based on BMI. Multivariable logistic regression was used to control for patient demographics and comorbidities. Odds ratios (OR) with 95% confidence intervals were reported. Results: We identified 4488 patients. The average BMI was 32.76 ± 7.70 kg/m². The majority of cases (76.8%) had wound classified as clean. The SSI rate significantly increased at a BMI of ≥ 35 kg/m² compared to < 35 (18.5% vs. 10.5%, p < 0.0001). There was no significant different in SSI rate between BMI 35–40 and > 40. After controlling for differences in baseline characteristics and wound classification, BMI ≥ 35 kg/m² was independently associated with SSI (OR 1.47, 1.21–1.78), minor complications (OR 1.65, 1.41–1.94), major complications (OR 1.91, 1.60–2.27), re-operation (OR 1.59, 1.23–2.05), and hospital re-admission (OR 1.93, 1.23–3.02). Conclusion: There is a significant increase in SSI and other perioperative complications in patients with a BMI ≥ 35 kg/m² undergoing AWR. Higher BMI is also independently associated with higher resource utilization in this patient population. Severely obese patients in need of AWR may benefit from a structured preoperative weight loss intervention.