Major article Epidemiology and outcomes associated with surgical site infection following bariatric surgery Teena Chopra MD, MPH *, Dror Marchaim MD, Ylinne Lynch BS, Chris Kosmidis MD, Jing J. Zhao PharmD, Sorabh Dhar MD, Naasha Gheyara MD, Deborah Turner BS, Don Gulish, Michael Wood MD, FACS, George Alangaden MD, Keith S. Kaye MD, MPH Detroit Medical Center and Wayne State University, Detroit, Michigan Key Words: Roux-en-Y gastric bypass surgery Obesity Risk adjusted score Background: Surgical site infection (SSI) is a frequent problem complicating bariatric surgery. However, the potential risk factors, risk stratification, and outcomes of SSIs in this patient population remain poorly defined. The aim of this prospective case-control study was to characterize better the risk factors and to improve risk stratification for SSIs following bariatric surgery. Methods: Patients studied had SSI following Roux-en-Y gastric bypass surgery (RYGBS) between November 2006 and March 2009 at Harper University Hospital and were each matched with 3 controls based on type of operative procedure, surgeon, and year of surgery. Thirty-day outcomes included mortality, hospital readmissions, outpatient procedures, and emergency room visits. A scoring system (BULCS score) was compared with the National Nosocomial Infections Surveillance system risk index using logistic regression. Results: In multivariate analysis, duration of surgery (odds ratio [OR], 3.3; 95% confidence interval [CI]: 1.62-6.74), diagnosis of bipolar disorder (OR, 3.341; 95% CI: 1.0-12.27), use of prophylactic antibiotics other than cefazolin (OR, 4.2; 95% CI: 1.47-11.69), and sleep apnea (OR, 1.8; 95% CI: 1.05-2.97) were significantly associated with SSI. Patients with SSI were more likely to have return emergency visits (OR, 4.96; 95% CI: 2.9-8.48), readmission (OR, 6.53; 95% CI: 3.44-12.42), and outpatient procedures following surgery (OR, 4.75; 95% CI: 1.32-17.14) than were controls without SSI. The BULCS score was a stronger predictor of SSI than the National Nosocomial Infections Surveillance system (C-statistic, 0.62 vs 0.55, respectively). Conclusion: SSI following bariatric surgery was associated with receipt of antibiotic prophylaxis other than cefazolin and comorbid conditions including sleep apnea and bipolar disorder. The BULCS score performed favorably as a predictor and risk adjuster for SSI following bariatric surgery. SSI was associated with increased health care resource utilization. Copyright Ó 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. The global epidemic of obesity has become a major public health problem. According to the latest National Health and Nutrition Examination Survey, over 30% of adults in the United States are obese (body mass index [BMI] > 30 [kg/m 2 ]), and over 60% are either overweight (BMI, 25-30) or obese. 1 It has been estimated that, by the year 2030, the prevalence of individuals who are overweight or obese in the United States will be greater than 80% in adults and greater than 30% in adolescents. 2 Obesity has been linked to many chronic problems, including hypertension, diabetes mellitus type 2, coronary artery disease, sleep apnea, and osteoar- thritis. 3 If the rise in obesity continues as predicted, by 2030, approximately 1 in 6 health care dollars spent, or approximately 900 billion dollars annually, would be directly attributable to problems associated with obesity and overweight. 2 Medical management of obesity has been effective only in certain instances. Bariatric surgery, a type of “weight loss” surgery, has been a revolutionary breakthrough in the management of obesity. A 2009 Cochrane Review reported that, in obese patients, surgical approaches were more effective weight loss interventions compared with nonsurgical approaches. 4 Patients who are eligible * Address correspondence to Teena Chopra, MD, Assistant Professor of Medicine, Division of Infectious Diseases, University Health Center, 4201 St Antoine Street, Suite 2B, Detroit, MI 48201. E-mail address: tchopra@med.wayne.edu (T. Chopra). Conflicts of interest: None to report. Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control 0196-6553/$36.00 - Copyright Ó 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.ajic.2011.10.015 American Journal of Infection Control 40 (2012) 815-9