Back to 2025 Abstracts
CAN ABDOMINAL WALL THICKNESS SERVE AS A PREDICTIVE FACTOR FOR SURGICAL SITE INFECTIONS IN ABDOMINAL SURGERIES?
Lovenish Bains
*, Uday Kumar, Pawan Lal, Shubham Ahuja
Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
BACKGROUNDSSI is a significant cause of illness and death, accounting for around 20% of healthcare-associated infections. Existing measures for identifying obesity as a risk factor for SSI, such as BMI and waist-hip ratio, have limitations. Our study aimed to assess whether abdominal wall thickness can predict SSI.
METHODSIn a prospective setting, Patients undergoing abdominal surgeries with incision >5 cm with various classes of wounds (I-IV in both elective as well as emergency surgery) were included. Ultrasonography was used to measure abdominal wall thickness, from the skin to the anterior rectus sheath. Six pre-determined points were chosen: in midline between xiphisternum and umbilicus, 2cm below umbilicus, and at the same level at midclavicular line on both right and left sides. The outcomes were SSI and Length of hospital stay (LOS). The occurrence of SSI in relation to AWT was assessed.
RESULTS205 patients were included over 1 year period, comprising 64 (Class I, 4% SSI rate, CI 95%; LOS 1±2 days; CI 95%), 61 (Class II, 14% SSI rate, CI 95%; LOS 3±2 days, CI 95%), and 80 (Class III [emergency laparotomy]; 31% SSI rate, CI 95%; LOS 6±4 days; CI 95%). The incidence of SSI in patients with an average AWT < 1.8cm was 7.9% and 58% for patients with average AWT ?1.8cm. The incidence of SSI with BMI 18-23 was 10%, it was 32% when BMI >25. A higher AWT > 1.8cm and BMI >25 kg/m
2 was associated with increased incidence of SSI which was statistically significant. However, in the multivariate analysis, only AWT was found to have better correlation.
DISCUSSIONA higher BMI>25 trended towards increased incidence of SSI (RR 9; CI>95%) but AWT>1.8cm (RR 17; CI> 95%) has shown a stronger correlation to SSI rate. BMI has been shown to have a high specificity for diagnosing obesity, but a low sensitivity for identifying adiposity, as it fails to identify patients with excess body fat percentage. While obesity is frequently described as a predictive factor for SSI, but it can be unreliable in many conditions due to variations in fat distribution, high muscular mass can have high BMI with less adiposity. AWT can serve as reliable predictor of SSI in abdominal surgeries and is easy to measure. Preoperative imaging of AWT can guide intraoperative decisions related to wound management. Further multicentric studies with large sample size are needed to strengthen our hypothesis.
Back to 2025 Abstracts
